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Surgery Today

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01-06-2013 | Original Article

Pancreaticoduodenectomy can be safely performed in the elderly

Authors: Shuji Suzuki, Satoshi Kaji, Nobusada Koike, Nobuhiko Harada, Mamoru Suzuki

Published in: Surgery Today | Issue 6/2013

Abstract

Background

Although pancreaticoduodenectomy has been recognized in the past for its severe complications, improvements in operative methods and perioperative management have made it a safe procedure. Therefore, pancreaticoduodenectomy can be performed in elderly patients, and our experience and outcomes are described in this report.

Methods

We retrospectively investigated 142 patients in whom pancreaticoduodenectomy was performed without stenting tubes during pancreaticojejunostomy. The patients were classified into two groups: (A) those older and (B) younger than 75 years. The outcomes, including preoperative characteristics, intraoperative characteristics, postoperative complications and mortality, are herein reported. Continuous variables were compared using Student’s t test and the Chi-square test.

Results

There were no differences between groups A and B in terms of sex, operative time, amount of blood loss, performance status, soft pancreas rate, disease distribution and operative procedure. Comorbidities in groups A and B were statistically different. Regarding the preoperative status, the elderly patients exhibited lower serum albumin and hemoglobin levels than the younger patients. There were no differences in mortality (0 vs. 0 %), morbidity (24.3 vs. 29.5 %, p = 0.362), postoperative hospital days or major complications such as pancreatic fistula development, delayed gastric emptying, intra-abdominal abscess development, biliary fistula formation and postpancreatectomy hemorrhage.

Conclusions

Pancreaticoduodenectomy can be safely performed in elderly as well as younger patients.

Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Nishioka R, et al. A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg. 2009;16:675–80 (Epub 2009 Apr 22).

Malleo G, Marchegiani G, Salvia R, Butturini G, Pederzoli P, Bassi C. Pancreaticoduodenectomy for pancreatic cancer: the Verona experience. Surg Today. 2011 41:463–70 (Epub 2011 Mar 23).

Kuroki T, Tajima Y, Kitasato A, Adachi T, Kanematsu T. Stenting versus non-stenting in pancreaticojejunostomy: a prospective study limited to a normal pancreas without fibrosis sorted by using dynamic MRI. Pancreas. 2011;40:25–9.PubMedCrossRef

Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg. 2011;253:879–85.PubMedCrossRef

Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007; 246:425–33 (discussion 433–5).

Winter JM, Cameron JL, Campbell KA, Chang DC, Riall TS, Schulick RD, et al. Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg. 2006;10:1280–90 (discussion 1290).

Imaizumi T, Hatori T, Tobita K, Fukuda A, Takasaki K, Makuuchi H. Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube. J Hepatobiliary Pancreat Surg. 2006;13:194–201.PubMedCrossRef

Suzuki S, Kaji S, Koike N, Harada N, Tanaka S, Hayashi T, et al. Pancreaticojejunostomy of duct to mucosa anastomosis can be performed more safely without than with a stenting tube. Am J Surg. 2009;198:51–4 (Epub 2009 Feb 13).

Smyrniotis V, Arkadopoulos N, Kyriazi MA, Derpapas M, Theodosopoulos T, Gennatas C, et al. Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study. Langenbecks Arch Surg. 2010;395:195–200.PubMedCrossRef

10.

Suzuki S, Kaji S, Koike N, Harada N, Hayashi T, Suzuki M, et al. Pancreaticoduodenectomies with a duct-to-mucosa pancreaticojejunostomy anastomosis with and without a stenting tube showed no differences in long-term follow-up. J Hepatobiliary Pancreat Sci. 2011;18:258–62.PubMedCrossRef

11.

Ishikawa A, Beppu M. Population statistics of Japan 2008. Tokyo: Yamato-Sogo; 2006.

12.

Ouaïssi M, Sielezneff I, Pirrò N, Merad A, Loundou A, Chaix JB, et al. Pancreatic cancer and pancreaticoduodenectomy in elderly patient: morbidity and mortality are increased. Is it the real life? Hepatogastroenterology. 2008;88:2242–6.

13.

Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.PubMedCrossRef

14.

Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D, et al. Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg. 2006;141:137–42.PubMedCrossRef

15.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, International Study Group on Pancreatic Fistula Definition, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef

16.

Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with pancreatic resections. Changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.PubMedCrossRef

17.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8.PubMedCrossRef

18.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142:20–5.PubMedCrossRef

19.

Kojima Y, Yasukawa H, Katayama K, Note M, Shimada H, Nakagawara G. Postoperative complications and survival after pancreatoduodenectomy in patients aged over 70 years. Surg Today. 1992;22:401–4.PubMedCrossRef

20.

Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430-5 (discussion 435–8).

21.

Hodul P, Tansey J, Golts E, Oh D, Pickleman J, Aranha GV. Age is not a contraindication to pancreaticoduodenectomy. Am Surg. 2001;67:270-5 (discussion 275–6).

22.

Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248:459–67.PubMed

23.

Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205:729–34 (Epub 2007 Oct 1).

24.

Lee MK, Dinorcia J, Reavey PL, Holden MM, Tsai WY, Stevens PD, et al. Pancreaticoduodenectomy can be performed safely in patients aged 80 years and older. J Gastrointest Surg. 2010;14:1838–46 (Epub 2010 Sep 8).

25.

Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.PubMedCrossRef

26.

Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.PubMedCrossRef

Title: Pancreaticoduodenectomy can be safely performed in the elderly
Authors: Shuji Suzuki
Satoshi Kaji
Nobusada Koike
Nobuhiko Harada
Mamoru Suzuki
Publication date: 01-06-2013
Publisher: Springer Japan
Published in: Surgery Today / Issue 6/2013
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-012-0383-6

2024 ASCO Annual Meeting

Springer Medicine

Pancreaticoduodenectomy can be safely performed in the elderly

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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