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- Title
Pancreatic resection in elderly patients: should it be denied?
- Authors
Adham, M.; Bredt, L.; Robert, M.; Perinel, J.; Lombard-Bohas, C.; Ponchon, T.; Valette, P.
- Abstract
Background: Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients. Methods: The medical records of all patients who underwent pancreatic resection at our institution (2005-2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years. Results: A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores ( P < 0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P = 0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P = 0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P = 0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P = 0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥70 years (HR, 3.5; 95 % CI, 1.3-9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6-96), and intraoperative blood loss were significant ( P = 0.012; P = 0.015, and P = 0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively ( P = 0.003). Conclusions: Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family.
- Subjects
PANCREATIC surgery; SURGICAL excision; OLDER patients; PANCREATIC cancer treatment; POSTOPERATIVE care; HEALTH outcome assessment; SURGICAL complications
- Publication
Langenbeck's Archives of Surgery, 2014, Vol 399, Issue 4, p449
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-014-1183-9