Radical Pancreatectomy for Pancreatic Cancer in the Elderly (original) (raw)
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Pancreatic Resection in Patients 80 Years or Older
Pancreas, 2014
The aim of this study was to evaluate the safety of pancreatic resections in patients 80 years or older. A systematic search of the literature was carried out that compared perioperative outcomes after pancreatic resection in patients 80 years or older with patients younger than 80 years. The primary end points were postoperative mortality and morbidity. The secondary end points were incidence of postoperative pancreatic fistula, delayed gastric emptying, bile leak, pneumonia, postoperative infection, cardiologic complications, reoperation, and length of hospital stay. Nine studies were found to be suitable for the meta-analysis. The postoperative mortality and morbidity were significantly higher in the group 80 years or older (P < 0.00001 and P = 0.003, respectively) except for patients in whom there were no differences in preoperative comorbidities (P = 0.56 and P = 0.36, respectively). Postoperative cardiac complications were significantly more frequent in patients 80 years or older (P < 0.0001), and the length of hospital stay was significantly longer in octogenarian patients (P = 0.008). Patients 80 years or older have an increased incidence of postoperative mortality, morbidity, and cardiac complications and a longer length of hospital stay than do younger patients. Thus, pancreatic resection can be recommended only in a selected group of patients 80 years or older.
Outcomes of Pancreatic Surgery in Patients Older than 70 Years
Cirugía Española (english Edition), 2015
Introduction: The proportion of elderly patients is growing rapidly. Knowing the results of pancreatic surgery in this group of patients would help surgeons to make therapeutic decisions. The objective is to evaluate the surgical outcomes of pancreatic resections in patients over 70 years. Method: Retrospective study including patients undergoing pancreatic resection during the period 2009-2014. The sample was divided into 2 groups. G1: Patients under 70 years and G2: Patients older than 70 years. Surgical results between the 2 groups were evaluated. Results: Seventy-three pancreatic resections were performed, 51 (70%) patients belonged to G1 and 22 (30%) to G2. There were no significant differences between G1 and G2 in terms of operative time and hospitalisation days. No significant difference was obtained in the incidence of delayed gastric emptying, pancreatic fistula or biliary fistula. The overall mortality in the series was 4.1% showing difference between both groups, with 2% in G1 and 13.6% in G2 (P=.04). When a sub-analysis in G2 was made, mortality in this group occurred only in patients with significant comorbidities with ASA3 (P=.004). Both groups with oncologic disease had similar overall survival and disease-free survival. Conclusions: Age should not be a limiting factor for pancreatic resections. The elderly have similar results as younger patients and their increased perioperative mortality is due to the presence of important associated comorbidities rather than age as an independent risk factor.
Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions
HPB Surgery, 2016
Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be 79,800perpatientandforeachresection79,800 per patient and for each resection 79,800perpatientandforeachresection164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage.Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented.Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial p...
Pancreatic surgery in elderly patients: results of 329 consecutive patients during 10 years
Frontiers in Medicine, 2023
Introduction: There is a progressive shift from a younger population to an older population throughout the world. With the population age shift, surgeons will be more encountered with older patient profiles. We aim to determine agerelated risk factors of pancreatic cancer surgery and the effect of patient age on outcomes after pancreatic surgery. Materials and methods: A retrospective review was conducted with data obtained from consecutive 329 patients whose pancreatic surgery was performed by a single senior surgeon between January 2011 and December 2020. Patients were divided into three groups based on age: patients younger than 65 years old, between 65 and 74 years old, and older than 74 years old. Demographics and postoperative outcomes of the patients were evaluated and compared between these age groups. Results: The distribution of a total of 329 patients into the groups was 168 patients (51.06%) in Group 1 (age <65 years old), 93 patients (28.26%) in Group 2 (age ≥65 and <75 years old), and 68 patients (20.66%) in Group 3 (age ≥75 years old). The overall postoperative complications were statistically significantly higher in Group 3 than in Group 1 and Group 2 (p = 0.013). The comprehensive complication index of the patients in each group was 23.1 ± 6.8, 20.4 ± 8.1, and 20.5 + 6.9, respectively (p = 0.33). Fisher's exact test indicated a significant difference in morbidity in patients with ASA 3-4 (p = 0.023). In-hospital or 90-day mortality was observed in two patients (0.62%), one from Group 2 and one from Group 3. The 3-year survival rates for each group were 65.4%, 58.8%, and 56.8%, respectively (p = 0.038). Conclusion: Our data demonstrate that comorbidity, ASA score, and the possibility of achieving a curative resection do have significantly more impact than age alone.
The role of surgery for pancreatic cancer: a 12-year review of patient outcome
The Ulster medical journal, 2010
Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival. All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test. 126 patients were identified from the database. The majority (106) had a Whipple's procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple's group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenoc...
Pancreaticoduodenectomy can be Performed Safely in Patients Aged 80 years and Older
Journal of Gastrointestinal Surgery, 2010
Background Surgery offers the only chance for cure in patients with pancreatic cancer, and a growing number of elderly patients are being offered resection. We examined outcomes after pancreaticoduodenectomy in patients 80 years and older. Methods We retrospectively collected data on pancreaticoduodenectomy patients from 1992 to 2009 to compare outcomes between patients older and younger than 80 years. Variables were compared using t-, Wilcoxon rank-sum, or Fisher's exact tests. Survival was compared using Kaplan-Meier analysis and log-rank test. Results Patients 80 years and older who underwent pancreaticoduodenectomy were similar with respect to sex, race, blood loss, operative times, reoperation, length of stay, and readmission compared to younger patients. There were no differences in overall complications (47% vs. 51%, p=0.54), major complications (19% vs. 25%, p=0.25), and mortality (5% vs. 4%, p=0.53) when comparing older to younger patients. In a subset who underwent pancreaticoduodenectomy for ductal adenocarcinoma, older patients (n=45) had a median survival time of 11.6 months compared to 18.1 months in younger patients (n=346; p<0.01). Conclusion Pancreaticoduodenectomy can be performed safely in select patients 80 years and older. Age alone should not dissuade surgeons from offering patients resection, though elderly patients with pancreatic ductal adenocarcinoma appear to have shorter survival than younger patients with the same disease.
Anz Journal of Surgery, 1989
A personal series of 50 major pancreatic reseaions has been reviewed to ~~'isess some issues of the operdtive decision in relation to a patient's expected outcome. An accurate histological diagnosis was not always available at the time of operation. At operation. 25 were thought to have invasive carcinoma of the pancreas and 14 to have ampullary carcinoma but the final histology demonslrdted these diagnoses as accurate in 21 a d 12 cases, wpcctively. The remaining 17 patients had a variety of histological findings which necessitated resection. Thirrycight per cent of patients had major postoperative morbidity resulting in a median postoperative stay of 21 days after a Whippk p d u r e and 28 days after total pancreatectomy. The perioperative mortality rate was 6%. The median survival was 12 months for patients with invasive pancreatic carcinoma. 37 months for patients with ampullary carcinoma and 19 months for the whole group: the 5-year survival results were 13%. 40% and 25%. respectively. It is concluded that surgical resection of small pamatic turnouts is justifd because some patients gain long-term survival with an acceptable risk of perioperative momlity and because the exact diagnosis may no(be established at the time of surgery.