Radical Pancreatectomy for Pancreatic Cancer in the Elderly

Abstract

Surgical resection provides the only potential cure for pancreatic cancer, yet resection in patients 70 years of age and older remains controversial because of presumed increased morbidity and mortality. Our aim was to determine the operative results in patients 70 years of age or older undergoing potentially curative radical pancreatic resection for pancreatic cancer from 1982 through 1987. Of 206 consecutive patients explored for potential resection, 42 patients (mean age, 75 years) had potentially curative procedures, including radical pancreaticoduodenectomy in 23 patients, total pancreatectomy in 8 patients, and distal pancreatectomy in 11 patients. Ductal adenocarcinoma was the most frequently encountered neoplasm (69%), but cystadenocarcinoma and islet cell carcinoma accounted for 12% and 7%, respectively. The overall operative mortality rate was 9%, while surgical morbidity was 28%, and medical morbidity was 12%. Overall median survival was 19 months, and 5-year survival was 4%. Despite the low overall incidence of resectability and postoperative cure rate for pancreatic carcinoma, exploration for potential curative resection should not necessarily be withheld for healthy, selected patients who are older than 70 years. Morbidity and mortality rates, although slightly greater than for patients who are older than 70 years, are acceptable.

Duct-to-Mucosa Pancreaticojejunostomy Compared to ‘Dunk’ after Whipple’s Resection

“…Specialized units can achieve operative mortality rates below 5%, morbidity rates below 30%, and hospital stays in the region of 2 or 3 weeks. Even the elderly can be operated on with comparable outcome [15][16]. A Bill roth-1-type reconstruction as used in the present series, with the biliary anastomosis in the natural position 4-5 cm distal to the duodenojejunal anastomosis, was first described by Watson [17], The excellent functional and physiological results of this method of restoration of gas trointestinal continuity after pancreaticoduodenectomy have been confirmed by others [18][19][20].…”

Chemoradiotherapy for Locally Advanced Pancreatic Carcinoma in Elderly Patients

“…Some studies have shown that for resectable pancreatic carcinoma, pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term outcome [17,18,19,20,21,22,23,24,25]. However, in locally advanced pancreatic carcinoma treated with chemoradiotherapy, the tolerability, efficacy of treatment and long-term outcome have not been discussed extensively.…”

Pancreatic cancer

“…Morbidity and mortality rates in patients older than 70 years are slightly higher (31 percent and nine percent, respectively), but still acceptable. 31 The pylorus-preserving pancreaticoduodenectomy (PPPD) has received considerable attention recently. PPPD differs from the classic pancreaticoduodenectomy in that the entire stomach including the pylorus and a 2-to 3-cm cuff of proximal duodenum are preserved.…”

“…Reported actuarial five-year survivals after curative resection have generally been dismal regardless of the type of resection performed, averaging about five to 10 percent. 25,31,37 Recently, however, several centers have reported encouraging results with markedly improved actuarial five-year survivals after curative resection approaching 20 to 25 percent. 26,27,38 The reasons for these improved results are unknown, but may be related to factors such as better preoperative staging, improved operative techniques and postoperative adjuvant chemoradiation therapy, inaccurate histology (e.g., misidentification of islet cell tumor or fibrosing pancreatitis), or to a change in tumor biology.…”