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Langenbeck's Archives of Surgery

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01-04-2014 | Original Article

Pancreatic resection in elderly patients: should it be denied?

Authors: M. Adham, L. C. Bredt, M. Robert, J. Perinel, C. Lombard-Bohas, T. Ponchon, P. J. Valette

Published in: Langenbeck's Archives of Surgery | Issue 4/2014

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.

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Title: Pancreatic resection in elderly patients: should it be denied?
Authors: M. Adham
L. C. Bredt
M. Robert
J. Perinel
C. Lombard-Bohas
T. Ponchon
P. J. Valette
Publication date: 01-04-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1183-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pancreatic resection in elderly patients: should it be denied?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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