Safety and Feasibility of Pancreaticoduodenectomy in the Elderly

Clinique de chirurgie digestive et endocrinienne, IMAD, University Hospital Centre, Hotel Dieu, Nantes, France.
Pancreas (Impact Factor: 2.96). 08/2011; 40(6):920-4. DOI: 10.1097/MPA.0b013e31821fd70b
Source: PubMed


To compare the clinical outcomes after pancreaticoduodenectomy (PD) in patients older than 70 years old against a matched cohort of patients younger than 70.
A search of the department database revealed that 285 consecutive patients underwent PD from 1996 to 2009. Forty-one patients (14%) were identified to be older than 70 years (group 1), and they were matched with 41 patients younger than 70 (group 2) according to sex, body mass index, American Society of Anesthesiologists score and tumor staging. Medical comorbidities, preoperative CA19-9 and hemoglobin levels, operative and histopathologic data, postoperative course, and survival outcomes were compared between the 2 groups of patients.
Statistical analyses revealed no significant difference between the 2 groups, except for preoperative CA19-9 and hemoglobin levels, operating time, duration of hospitalization, and the number of lymph nodes removed. These parameters, however, did not have an impact on morbidity, mortality, and overall survival.
Based on our study, perioperative morbidity, mortality, and overall survival are not poorer in patients older than 70. Thus, PD should not be contraindicated solely on the basis of chronological age. Moreover, PD can be rationally proposed to patients meeting the "fit elderly" definition.

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    • "The results of several series [22-26] suggest that age is unrelated to morbidity and mortality and that PD can be performed safely if it is provided by appropriate indication and management. Our study also addresses the safety of PD management in elderly patients and supports these opinions. "
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    ABSTRACT: The elderly population has increased in many countries. Indications for cancer treatment in elderly patients have expanded, because surgical techniques and medical management have improved remarkably. Pancreaticoduodenectomy (PD) requires high-quality techniques and perioperative management methods. If it is possible for elderly patients to withstand an aggressive surgery, age should not be considered a contraindication for PD. Appropriate preoperative evaluation of elderly patients will lead to their safer management. The purpose of the present study was to evaluate the safety of PD in patients older than 75 years and to show the influence of advanced age on the morbidity and mortality associated with this operation. Subjects were 98 patients who underwent PD during the time period from April 2005 to April 2011. During this study, 31 patients were 75 years of age or older (group A), and the other 67 patients were less than 75 years old (group B). Preoperative demographic and clinical data, surgical procedure, pathologic diagnosis, postoperative course and complication details were collected prospectively and they were analyzed in two group. There was no statistical difference between patient groups in terms of gender, comorbidity, preoperative drainage, diagnosis, or laboratory data. Preoperative albumin values were lower in group A (P = 0.04). The mean surgical time in group A was 408.1 ± 73.47 min. Blood loss and blood transfusion were not significantly different between both groups. There was no statistical differences in mortality rate (P = 0.14), morbidity rate (P = 0.43), and mean length of hospital stay (P = 0.22) between both groups. Long-term survival was also no statistically significant difference between the two groups using the log-rank test (P = 0.10). It cannot be ignored that the elderly population is getting larger. We must investigate the management of elderly patients after PD and prepare further for more experiences of PD. If appropriate surgical management is provided to elderly patients, we suggest that PD will lead to no adverse effects after surgery, and PD can be performed safely in elderly patients. We conclude that age should not be a contraindication to PD.
    Full-text · Article · Sep 2011 · World Journal of Surgical Oncology
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    ABSTRACT: The risks associated with pancreaticoduodenectomy (PD) in elderly patients continue to be debated. The aim of our study was to assess the incidence of death and postoperative complications following PD and identify the risk factors in patients >75 y. All patients who underwent PD between January 2000 and September 2009 were analyzed retrospectively. Patients were divided into two groups according to age (Group 1: patients aged <75 y, and Group 2: patients aged ≥75 y). Morbidity and perioperative mortality risk factors were analyzed using univariate and multivariate analyses. Among the 314 patients, 273 were included in Group 1 (sex ratio 1.4) and 41 in Group 2 (sex ratio 1). In multivariate analysis, postoperative hemorrhage (PH) (OR 6.61, IC95% [1.96; 22.31], P = 0.002) and age >75 y proved to be predictive factors for mortality (OR 11.04, IC95% [2.57; 47.49], P = 0.001). When compared with Group 1, Group 2 was associated with increased postoperative deaths (24.4% versus 3.66%, P < 0.001) and pancreatic fistulas (26.8% versus 13.2%, P = 0.041), in particular, Grade C fistulas (14.6% versus 4.4%, P = 0.023). In multivariate analysis, only PH proved to be an independent predictive factor for mortality (OR 12.9, IC95% [1.07; 155.5], P = 0.04). PD in elderly patients aged over 75 y appears to be associated with an increased risk of postoperative death and pancreatic fistula. No single preoperative factor made it possible to predict this risk.
    No preview · Article · Apr 2012 · Journal of Surgical Research
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    ABSTRACT: There is increasing focus on disease-specific outcomes. This study was undertaken to analyze early mortality after pancreaticoduodenectomy as part of a strategy to improve long-term outcome. One thousand thirty-one patients who underwent pancreaticoduodenectomy from 1992 to 2010 were studied. Median data are reported. Fifty-eight (5.6 %) patients died within 90 days after pancreaticoduodenectomy. All patients had at least one significant comorbidity, commonly cardiorespiratory in nature (76 %). Sixty percent of patients had depressed serum albumin levels, and 43 % were jaundiced. The American Society of Anesthesiologists class was: 17 % class II, 72 % class III, and 10 % class IV. Seventy-four percent had malignant disease. Twenty-two percent of patients underwent a major vascular resection at the time of pancreaticoduodenectomy. Causes of death were vascular/bleeding related (26 %), cardiorespiratory causes (17 %), multiorgan failure (12 %), leak/perforation (10 %), cancer progression (9 %), infection (7 %), or indeterminate (19 %). Death within 90 days after pancreaticoduodenectomy is uncommon, occurs in relatively older deconditioned patients, and is generally not causally related to underlying malignancy. Early death is generally associated with vascular or bleeding complications. Strategies to minimize early death should focus on careful patient selection and prompt recognition and management of herald bleeding or vascular thrombosis, as it can often result in perioperative death following pancreaticoduodenectomy.
    No preview · Article · Aug 2012 · Journal of Gastrointestinal Surgery
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