The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits

Melis, Marcovalerio; Marcon, Francesca; Masi, Antonio; Pinna, Antonio; Sarpel, Umut; Miller, George; Moore, Harvey G.; Cohen, Steven M.; Berman, Russell S.; Pachter, H. Leon; Newman, Elliot

doi:10.1111/j.1477-2574.2012.00484.x

Cited by 76 publications

(71 citation statements)

References 12 publications

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“…8 Melis et al also reported that the OS was 13.1 months in the patients who were less than 80 years of age and 17.3 months in the patients who were 80 years of age or older after a median follow-up of 35 months. 9 On the contrary, Oliveira-Cunha et al reported that the OS was 57.3 months in the patients who were less than 70 years of age and 78.7 months in the patients who were 70 years of age or older (P , 0.001).…”

Section: Discussionmentioning

confidence: 92%

“…20 In contrast, Melis et al evaluated the short-term outcomes and longterm survival after PD for pancreatic adenocarcinoma in 200 patients and divided them into 2 groups using a cutoff value of 80 years old. 9 They reported that overall morbidity and length of postoperative stay were increased in elderly patients compared with younger ones (44.0% versus 68.0%, P ¼ 0.03 and 13.7 versus 20 days, P ¼ 0.01, respectively). These data suggest that when complications occur in elderly patients, they rapidly increase in severity.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, few authors have evaluated the short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients aged 75 years and older. [8][9][10][11] Therefore, the short-term outcomes and long-term survival of pancreatic resection for pancreatic adenocarcinoma in elderly patients are still unclear. In addition, generally, elderly patients often have comorbidities and age-related physiologic problems that can lead to greater postoperative complications or poor survival than in nonelderly patients.…”

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confidence: 99%

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The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

Aoyama

Murakawa

Atsumi

et al. 2016

International Surgery

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The short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age , 75 years; group A) and elderly patients (age 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P ¼ 0.379 and P ¼ 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P ¼ 0.946 and 13.1% versus 16.0%, P ¼ 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.Key words: Pancreatic cancer -Elderly patient -Pancreatic resection P ancreatic cancer is one of the most lethal human cancers. It is the fifth-most common cancer and the fourth leading cause of cancer-related mortality worldwide, with a 5-year survival rate of less than 5% in all stages.1,2 Complete resection is essential for obtaining a cure in patients with pancreatic cancer. However, the morbidity after pancreatic resection has been reported to range from 30% to 65%, and the complications are sometimes fatal. [3][4][5][6][7] The number of elderly patients is rapidly growing worldwide. With people aged 75 and older representing the fastest growing subset of the population, the management of complex surgical issues promises to become even more challenging. However, previous studies excluded patients over the age of 75. Furthermore, few authors have evaluated the short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients aged 75 years and older. [8][9][10][11] Therefore, the short-term outcomes and long-term survival of pancreatic resection for pancreatic adenocarcinoma in elderly patients are still unclear. In addition, generally, elderly patients often have comorbidities and age-related physiologic problems that can lead to greater postoperative complications or poor survival than in nonelderly patients.We retrospectively investigated the short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years and compared them with nonelderly patients. Patients and Methods PatientsThe study subjects were selected from t...

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

Aoyama

Murakawa

Atsumi

et al. 2016

International Surgery

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“…Although some authors have found similar complication rates between groups, others have shown that elderly patients usually have longer stay in the intensive care unit (ICU) and require more readmissions after PD (4)(5)(6). Recent publications are focused in establishing perioperative factors associated with overall morbidity and classifying severity of the complications, as mild ones have little clinical significance (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Advanced age does not increase morbidity in pancreaticoduodenectomy

Namur¹,

Dantas²,

Jureidini³

et al. 2018

J. Gastrointest. Oncol.

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Background: Due to rising life expectancy of population, very complex surgical procedures such as pancreaticoduodenectomy (PD), are more commonly being performed in elderly patients. The objective of this study was to evaluate the safety of PD in patients older than 75 years old and the risk factors associated with severe complications.Methods: Patients who underwent PD for periampullary tumors were retrospectively reviewed and divided into two groups, A (<75 years) and B (>75 years). The primary endpoint was severe postoperative complications (Clavien 3 or greater). Secondary endpoints were mortality and any complications.Results: Ninety consecutive patients underwent PD for periampullary tumors in the studied period, 70 in group A and 20 in group B. Clinical and pathological characteristics of both groups were equivalents except for age. There were no difference regarding the incidence of severe complications (17% vs. 10%, P=0.72) or all complications (50% vs. 50%, P>0.999). Although mortality was greater in group A (8.6% vs. 0%), it was not statistically significant (P=0.333). On multivariate analyses, only male sex, obesity and American Society of Anesthesiology Score of 3 or 4 were associated with severe postoperative complications. Conclusions:Poor clinical status, obesity and male gender are associated with severe complications in PD, but not age greater than 75 years, therefore PD can be considered safe in elderly patients and age itself should not be a contraindication for PD.

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“…Tailor S. Ryall has summarized the studies regarding the long-term outcomes following pancreatoduodenectomy for PDAC in different age groups to show a tendency toward decreased survival among the elderly patients [3,4,5,6,7,8,9,10,11]. However, factors influencing long-term survival in elderly were not depicted.…”

Section: Introductionmentioning

confidence: 99%

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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The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits

Abstract: As 30-day mortality and survival are similar to those observed in younger patients, a PD can be offered to carefully selected octogenarians.

Cited by 76 publications

References 12 publications

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

Advanced age does not increase morbidity in pancreaticoduodenectomy

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

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