Pancreaticoduodenectomy in the Very Elderly

Makary, Martin A.; Winter, Jordan M.; Cameron, John L.; Campbell, Kurtis A.; Chang, David C.; Cunningham, Steven C.; Riall, Taylor S.; Yeo, Charles J.

doi:10.1016/j.gassur.2005.12.014

Cited by 215 publications

(247 citation statements)

References 13 publications

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“…Our series demonstrated decreased median survival in the elderly (13.8 vs. 16.3 months), similarly to those reported by Makary et al (11 and 18 months) [19] and Minna K. Lee et al (11.6 and 18.6 months, respectively) [20]. Yamashita et al observed no significant differences in disease-free and overall survival in patients younger or older than 75 years [18].…”

Section: Discussionsupporting

confidence: 89%

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Urbonas¹,

Gulbinas

Smailytė

et al. 2015

Dig Surg

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Background: It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups. Methods: Data of 251 patients after pancreatoduodenectomy for PDAC between 1999 and 2012 were analyzed. The Kaplan-Meier method and log-rank test were used to calculate survival and to compare differences between groups. The Cox proportional hazard model was applied to indentify independent prognosticators. Results: The overall median survival was 14.9 months. Postoperative morbidity was 25.5% with a 5.1% mortality rate. No significant differences in the overall morbidity (22.4 vs. 29.6%) or mortality (2.8 vs. 8.3%) rates were observed between different patients' age groups (<70 years and >70 years). Multivariate analysis revealed R1 resection (HR 1.76) and poor tumor differentiation (G3-G4) (HR 1.48) were independent negative factors for survival in patients <70 years. Lymph-node metastases (N1) - HR 4.89 and perineural invasion - HR 2.73 were independent prognosticators in the elderly. Conclusions: Our study highlighted different factors influencing long-term survival after pancreatoduodenectomy: R1 resection and poor tumor differentiation (G3-G4) were independent negative factors for survival in patients <70 years, while perineural invasion and lymph-node metastases result in worse survival among the elderly.

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Section: Discussionsupporting

confidence: 89%

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Urbonas¹,

Gulbinas

Smailytė

et al. 2015

Dig Surg

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“…Although we cannot determine the underlying reason for this association, our results are consistent with those reported from the National Cancer Data Base (NCDB) [14]. In a single-institution report of patients receiving pancreaticoduodenectomy, Makary et al [15] reported higher mortality and complication rates in the 80-to 89-year age group (4.1% and 52.8%, respectively) compared with patients <79 years of age (1.7% and 41.6%, respectively). However, because age was not independently associated with perioperative mortality or morbidity, they argued that age alone should not be a barrier to surgery.…”

Section: Discussionsupporting

confidence: 88%

Sociodemographic and tumor characteristics associated with pancreatic cancer surgery in the United States

Gawron

Gapstur

Fought

et al. 2008

Journal of Surgical Oncology

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“…Use of these diagnosis-related risk groups allowed us to risk stratify PD outcomes for elderly patients. Sohn et al 3 and Makary et al 24 reported only small differences in surgical outcomes as a function of indication after PD. However, in both studies, patients were grouped according to the pathologic type of disease (benign and malignant).…”

Section: Discussionmentioning

confidence: 99%

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Bergquist¹,

Shubert²,

Ubl³

et al. 2016

HPB

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Background: Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods:The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and 80 years) who underwent PD from January 1, 2005, through December 31, 2012. High-and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes.Results: Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients 80 years with low-risk diagnoses. Conclusion:In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication.Patients should receive preoperative counseling about their risk.

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Pancreaticoduodenectomy in the Very Elderly

Cited by 215 publications

References 13 publications

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Sociodemographic and tumor characteristics associated with pancreatic cancer surgery in the United States

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

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