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For: Kow AWC, Sadayan NA, Ernest A, Wang B, Chan CY, Ho CK, Liau KH. Is pancreaticoduodenectomy justified in elderly patients? Surgeon 2011;10:128-36. [PMID: 22525414 DOI: 10.1016/j.surge.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/29/2011] [Accepted: 02/25/2011] [Indexed: 12/18/2022]

For:	Kow AWC, Sadayan NA, Ernest A, Wang B, Chan CY, Ho CK, Liau KH. Is pancreaticoduodenectomy justified in elderly patients? Surgeon 2011;10:128-36. [PMID: 22525414 DOI: 10.1016/j.surge.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 01/29/2011] [Accepted: 02/25/2011] [Indexed: 12/18/2022]

Number

Cited by Other Article(s)

Zhao Z, Zhou S, Tang Y, Zhou L, Ji H, Tang Z, Dai R. Impact of age on short-term outcomes after pancreaticoduodenectomy: A retrospective case-control study of 260 patients. Front Surg 2023;10:1031409. [PMID: 37066018 PMCID: PMC10097935 DOI: 10.3389/fsurg.2023.1031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open

Raza SS, Nutu OA, Powell-Brett S, Carvalheiro Boteon A, Hodson J, Abradelo M, Dasari B, Isaac J, Chatzizacharias N, Marudanayagam R, Mirza DF, Roberts JK, Sutcliffe RP. Impact of an enhanced recovery after surgery protocol on short-term outcomes in elderly patients undergoing pancreaticoduodenectomy. HPB (Oxford) 2022;24:1720-1728. [PMID: 35643908 DOI: 10.1016/j.hpb.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 12/12/2022]

Abstract

BACKGROUND

To determine whether the short-term benefits associated with an enhanced recovery after surgery programme (ERAS) following pancreaticoduodenectomy (PD) vary with age.

METHODS

830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (≥75 years) vs. non-elderly patients (<75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then performed, to assess whether ERAS was independently associated with length of hospital stay (LOS).

RESULTS

Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged ≥75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p < 0.001) and 6.0 vs. 5.7 (p = 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical complications in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p = 0.002), but not in elderly patients (23.6% vs. 14.0%; p = 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p = 0.041) and non-elderly patients (15.6% reduction, 95% CI: 9.2-21.6%, p < 0.001), with the effect size being similar in each group.

CONCLUSION

ERAS protocols can be safely applied to patients undergoing pancreaticoduodenectomy irrespective of age. Implementation of an ERAS protocol was associated with a significant reduction in postoperative LOS in both elderly and non-elderly patients, despite higher comorbidity in the post-ERAS period.

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Suyama Y, Haruki K, Hamura R, Tsunematsu M, Shirai Y, Taniai T, Yanagaki M, Furukawa K, Onda S, Shiba H, Ikegami T. Strategies and tactics to perform safe pancreaticoduodenectomy for 94-year-old patient: report of a case. Surg Case Rep 2022;8:39. [PMID: 35244810 PMCID: PMC8897542 DOI: 10.1186/s40792-022-01395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022] Open

Abstract

Background

Despite improvement of postoperative management, pancreatoduodenectomy still has a high rate of major complications. Therefore, careful assessment is critically important when we consider high risk surgery for extremely elderly patients.

Case presentation

A 94-year-old man, who suffered dark urine, epigastric pain, and loss of appetite, was diagnosed as bile duct cancer and underwent endoscopic retrograde biliary drainage. He has past history of hypertension and paroxysmal atrial fibrillation. Computed tomography (CT) showed a nodule in the lower bile duct, which was slowly enhanced by dynamic CT. The patient was evaluated whether he overcomes pancreatoduodenectomy by cardiac ultrasonography, brain magnetic resonance angiography, nutritional evaluation (rapid turnover proteins), and CT-based general assessment, including sarcopenia and osteopenia. The patient was independent in activities of daily living and has enough ejection fraction of 65%, and examinations revealed no impairment of cognitive function, sarcopenia, and osteopenia. With a diagnosis of bile duct cancer with no distant metastasis, the patient underwent subtotal stomach-preserving pancreatoduodenectomy with lymph node dissection. Operation time was 299 min and estimated blood loss was 100 ml. Pathological examination revealed papillary adenocarcinoma of the bile duct (pT3N1M0 Stage IIIB). Enteral nutrition was given through jejunostomy and then the patient started oral intake after an evaluation of swallowing function. Postoperative course was uneventful and all drains including pancreatic duct stent, biliary stent, and jejunostomy were removed by 3 weeks after operation. The levels of rapid turnover proteins dropped at postoperative day 7, but recovered at 1 month after operation via appropriate nutrition and rehabilitation. He remains well with no evidence of tumor recurrence as of 1 year after resection.

Conclusions

We herein report successfully treated cases of bile duct cancer in 94-year-old patient by pancreatoduodenectomy with careful evaluation of osteopenia, sarcopenia and nutrition.

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Affiliation(s)

Yu Suyama Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Koichiro Haruki Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Ryoga Hamura Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Masashi Tsunematsu Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Yoshihiro Shirai Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Tomohiko Taniai Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Mitsuru Yanagaki Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Kenei Furukawa Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Shinji Onda Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Hiroaki Shiba Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
Toru Ikegami Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

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Kim JS, Choi M, Kim SH, Choi SH, Kang CM. Safety and feasibility of laparoscopic pancreaticoduodenectomy in octogenarians. Asian J Surg 2022;45:837-843. [PMID: 34649792 DOI: 10.1016/j.asjsur.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 01/04/2023] Open

Tsukagoshi M, Harimoto N, Araki K, Kubo N, Watanabe A, Igarashi T, Ishii N, Yamanaka T, Hagiwara K, Hoshino K, Muranushi R, Yajima T, Shirabe K. Skeletal Muscle Loss and Octogenarian Status Are Associated with S-1 Adjuvant Therapy Discontinuation and Poor Prognosis after Pancreatectomy. Cancers (Basel) 2021;13:cancers13164105. [PMID: 34439259 PMCID: PMC8391507 DOI: 10.3390/cancers13164105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 01/06/2023] Open

Abstract

Simple Summary

Significant advances in surgical techniques and perioperative care, together with adjuvant chemotherapy, have contributed to the increasing number of patients with pancreatic cancer undergoing surgery. However, the results of some studies suggest that the postoperative complications and mortality might be higher in elderly patients undergoing pancreatectomy. We aimed to identify the utility of S-1 adjuvant chemotherapy in elderly patients with resected pancreatic cancer. In our cohort of 80 patients, including 16 octogenarians, univariate and multivariate analyses revealed that S-1 adjuvant chemotherapy was associated with improved prognosis in patients with pancreatic cancer. However, we also observed that skeletal muscle loss and age of 80 years or older predicted the failure to complete adjuvant chemotherapy with S-1. We propose that evaluation of skeletal muscle mass should be considered as a useful preoperative assessment approach for determining feasibility of adjuvant chemotherapy in elderly patients.

Abstract

The efficacy and prognosis of adjuvant chemotherapy for resected pancreatic cancer remain unclear. We investigated the utility and risk factors of S-1 adjuvant chemotherapy in patients with pancreatic cancer undergoing pancreatectomy. This study comprised 80 patients, including 58 patients who received S-1 adjuvant chemotherapy. Skeletal muscle loss was defined using cutoff values of skeletal muscle mass index. In total, 16 (20%) octogenarian patients underwent pancreatectomy. Skeletal muscle loss was present in 56 (70%) patients. The entire course of S-1 adjuvant chemotherapy for 6 months was completed in 33 patients (41%). S-1 adjuvant chemotherapy <6 months was an independent prognostic indicator of poor overall survival. Patients who completed S-1 adjuvant chemotherapy exhibited significantly longer overall and relapse-free survival rates than those did not complete the chemotherapy (p < 0.0001 and p = 0.0003, respectively). Being an octogenarian and skeletal muscle loss were independent variables associated with the discontinuation of S-1 adjuvant chemotherapy. Finally, the S-1 adjuvant chemotherapy rates were 6.3% (1/16) and 28.6% (16/56) in octogenarian patients and those with skeletal muscle loss, respectively. S-1 adjuvant chemotherapy completion was associated with improved prognosis in patients with pancreatic cancer. Skeletal muscle loss and octogenarian status predicted the failure of S-1 adjuvant chemotherapy completion.

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Affiliation(s)

Mariko Tsukagoshi Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi 371-8511, Japan; (M.T.); (T.Y.) Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Norifumi Harimoto Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.) Correspondence: ; Tel.: +81-27-220-8224
Kenichiro Araki Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Norio Kubo Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Akira Watanabe Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Takamichi Igarashi Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Norihiro Ishii Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Takahiro Yamanaka Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Kei Hagiwara Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Kouki Hoshino Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Ryo Muranushi Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)
Toshiki Yajima Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi 371-8511, Japan; (M.T.); (T.Y.)
Ken Shirabe Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-Machi, Maebashi 371-8511, Japan; (K.A.); (N.K.); (A.W.); (T.I.); (N.I.); (T.Y.); (K.H.); (K.H.); (R.M.); (K.S.)

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Short-term outcomes after minimally invasive versus open pancreaticoduodenectomy in elderly patients: a propensity score-matched analysis. BMC Surg 2021;21:60. [PMID: 33494734 PMCID: PMC7836577 DOI: 10.1186/s12893-021-01052-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/06/2021] [Indexed: 01/04/2023] Open

Kang CM, Lee JH, Choi JK, Hwang HK, Chung JU, Lee WJ, Kwon KH. Can we recommend surgical treatment to the octogenarian with periampullary cancer?: National database analysis in South Korea. Eur J Cancer 2020;144:81-90. [PMID: 33341449 DOI: 10.1016/j.ejca.2020.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]

Di Franco G, Palmeri M, Guadagni S, Furbetta N, Gianardi D, Bronzoni J, Palma A, Bianchini M, Musetti S, Bastiani L, Caprili G, Biancofiore G, Mosca F, Di Candio G, Morelli L. Pancreatic resections in elderly patients with high American Society of Anesthesiologists' risk score: a view from a tertiary care center. Aging Clin Exp Res 2020;32:935-950. [PMID: 31347102 DOI: 10.1007/s40520-019-01276-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/12/2019] [Indexed: 02/08/2023]

Affiliation(s)

Gregorio Di Franco General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Matteo Palmeri General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Simone Guadagni General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Niccolò Furbetta General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Desirée Gianardi General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Jessica Bronzoni General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Alessandro Palma General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Matteo Bianchini General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Serena Musetti General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Luca Bastiani Institute of Clinical Physiology, National Council of Research, Pisa, Italy
Giovanni Caprili General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Giandomenico Biancofiore Division of Transplant Anesthesia and Critical Care, University of Pisa, Pisa, Italy
Franco Mosca EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
Giulio Di Candio General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
Luca Morelli General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.

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Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms. Gastroenterol Res Pract 2020;2020:1793051. [PMID: 32382261 PMCID: PMC7183022 DOI: 10.1155/2020/1793051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/24/2020] [Accepted: 03/30/2020] [Indexed: 12/20/2022] Open

Abstract

Background

Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients.

Methods

124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates.

Results

A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p = 0.004), Karnofsky Score (p = 0.025), preoperative jaundice (p = 0.004), and pulmonary complications (p = 0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p = 0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p = 0.909).

Conclusion

PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

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Shatveryan GA, Chardarov NK, Nikoda VV, Bagmet NN, Tadzhibova IM, Lishova EA, Ratnikova NP, Karagyozyan GA. [Short-term results of pancreatoduodenectomy in patients over 70 years old]. Khirurgiia (Mosk) 2020:25-32. [PMID: 31994496 DOI: 10.17116/hirurgia202001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]

Wong SS, Hsu FC, Avis NE, Clark CJ. Health-related quality of life and medical comorbidities in older patients with pancreatic adenocarcinoma: An analysis using the 1998-2011 surveillance, epidemiology, and end results-medicare health outcomes survey data. J Geriatr Oncol 2019;11:633-639. [PMID: 31515163 DOI: 10.1016/j.jgo.2019.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/07/2019] [Accepted: 08/21/2019] [Indexed: 01/19/2023]

Pancreatoduodenectomy for pancreatic head tumors in the elderly - Systematic review and meta-analysis. Surg Oncol 2018;27:346-364. [PMID: 30217288 DOI: 10.1016/j.suronc.2018.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 02/06/2023]

Chen YT, Ma FH, Wang CF, Zhao DB, Zhang YW, Tian YT. Elderly patients had more severe postoperative complications after pancreatic resection: A retrospective analysis of 727 patients. World J Gastroenterol 2018;24:844-851. [PMID: 29467554 PMCID: PMC5807942 DOI: 10.3748/wjg.v24.i7.844] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open

Kakizawa N, Noda H, Watanabe F, Ichida K, Suzuki K, Rikiyama T. A High Abdominal Aortic Calcification Score on CT is a Risk Factor for Postoperative Pancreatic Fistula in Elderly Patients Undergoing Pancreaticoduodenectomy. World J Surg 2017;42:1129-1137. [DOI: 10.1007/s00268-017-4240-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]

Shamali A, De’Ath HD, Jaber B, Abuawad M, Barbaro S, Hamaday Z, Abu Hilal M. Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy. Int J Surg 2017;45:138-143. [PMID: 28782662 DOI: 10.1016/j.ijsu.2017.07.106] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]

Paiella S, De Pastena M, Pollini T, Zancan G, Ciprani D, De Marchi G, Landoni L, Esposito A, Casetti L, Malleo G, Marchegiani G, Tuveri M, Marrano E, Maggino L, Secchettin E, Bonamini D, Bassi C, Salvia R. Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center. World J Gastroenterol 2017;23:3077-3083. [PMID: 28533664 PMCID: PMC5423044 DOI: 10.3748/wjg.v23.i17.3077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/20/2017] [Accepted: 03/31/2017] [Indexed: 02/07/2023] Open

Kim JH, Min SK, Lee H, Hong G, Lee HK. The safety and risk factors of major hepatobiliary pancreatic surgery in patients older than 80 years. Ann Surg Treat Res 2016;91:288-294. [PMID: 27904850 PMCID: PMC5128374 DOI: 10.4174/astr.2016.91.6.288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/19/2016] [Accepted: 08/03/2016] [Indexed: 12/30/2022] Open

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford) 2016;18:900-907. [PMID: 27594118 PMCID: PMC5094480 DOI: 10.1016/j.hpb.2016.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/17/2016] [Accepted: 07/23/2016] [Indexed: 02/07/2023]

Varley PR, Geller DA, Tsung A. Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective. J Surg Res 2016. [PMID: 28624034 DOI: 10.1016/j.jss.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

El Nakeeb A, Atef E, El Hanafy E, Salem A, Askar W, Ezzat H, Shehta A, Abdel Wahab M. Outcomes of pancreaticoduodenectomy in elderly patients. Hepatobiliary Pancreat Dis Int 2016;15:419-427. [PMID: 27498583 DOI: 10.1016/s1499-3872(16)60105-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]

Abstract

BACKGROUND

Although the mortality and morbidity of pancreaticoduodenectomy (PD) have improved significantly over the past years, the concerns for elderly patients undergoing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly patients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients.

METHODS

We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I (patients aged <60 years), group II (those aged 60 to 69 years) and group III (those aged ≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate.

RESULTS

A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579 (69.9%) patients in group I, 201 (24.3%) in group II, and 48 (5.8%) in group III. The overall incidence of complications was higher in elderly patients (25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006). There were more patients complicated with delayed gastric emptying in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality.

CONCLUSIONS

PD can be performed safely in selected elderly patients. Advanced age alone should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of associated comorbidities.

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Maggi JC, Hogg ME, Zureikat AH, Zeh HJ. Update on the Management of Pancreatic Cancer: Determinants for Surgery and Widening the Therapeutic Window of Surgical Resection. CURRENT SURGERY REPORTS 2016. [DOI: 10.1007/s40137-016-0146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]

Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy. Ann Surg 2016;263:385-91. [PMID: 25563871 DOI: 10.1097/sla.0000000000001093] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Abstract

BACKGROUND

For pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers.

METHODS

We identified 2694 patients who underwent pancreatic resection from the American College of Surgeons' National Surgical Quality Improvement Pancreatectomy Demonstration Project at 37 high-volume centers. Overall morbidity and in-hospital mortality were determined in patients younger than 80 years (N = 2496) and 80 years or older (N = 198). Failure to rescue was the number of deaths in patients with complications divided by the total number of patients with postoperative complications.

RESULTS

No significant differences were observed between patients younger than 80 years and those 80 years or older in the rates of overall complications (41.4% vs 39.4%, P = 0.58). In-hospital mortality increased in patients 80 years or older compared to patients younger than 80 years (3.0% vs 1.1%, P = 0.02). Failures to rescue rates were higher in patients 80 years or older (7.7% vs 2.7%, P = 0.01). Across 37 high-volume centers, unadjusted complication rates ranged from 25.0% to 72.2% and failure to rescue rates ranged from 0.0% to 25.0%. Among patients with postoperative complications, comorbidities associated with failure to rescue were ascites, chronic obstructive pulmonary disease, and diabetes. Complications associated with failure to rescue included acute renal failure, septic shock, and postoperative pulmonary complications.

CONCLUSIONS

In experienced hands, the rates of complications after pancreatectomy in patients 80 years or older compared to patients younger than 80 years were similar. However, when complications occurred, older patients were more likely to die. Interventions to identify and aggressively treat complications are necessary to decrease mortality in vulnerable older patients.

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Wagner D, DeMarco MM, Amini N, Buttner S, Segev D, Gani F, Pawlik TM. Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg 2016;8:27-40. [PMID: 26843911 PMCID: PMC4724585 DOI: 10.4240/wjgs.v8.i1.27] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/19/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open

Abstract

According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.

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Chou WC, Liu KH, Lu CH, Hung YS, Chen MF, Cheng YF, Wang CH, Lin YC, Yeh TS. To Operate or Not: Prediction of 3-Month Postoperative Mortality in Geriatric Cancer Patients. J Cancer 2016;7:14-21. [PMID: 26722355 PMCID: PMC4679376 DOI: 10.7150/jca.13126] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022] Open

Urbonas K, Gulbinas A, Smailyte G, Pranys D, Jakstaite A, Pundzius J, Barauskas G. Factors influencing survival after pancreatoduodenectomy for ductal adenocarcinoma depend on patients' age. Dig Surg 2015;32:60-67. [PMID: 25721397 DOI: 10.1159/000371856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/31/2014] [Indexed: 12/10/2022]

[Pancreatic resection in the elderly : Is the risk justified?]. Chirurg 2014;86:670-5. [PMID: 25234504 DOI: 10.1007/s00104-014-2869-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]

Implementing an Enhanced Recovery Program After Pancreaticoduodenectomy in Elderly Patients: Is It Feasible? World J Surg 2014;39:251-8. [PMID: 25212064 DOI: 10.1007/s00268-014-2782-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]

Tamburrino D, Partelli S, Crippa S, Manzoni A, Maurizi A, Falconi M. Selection criteria in resectable pancreatic cancer: A biological and morphological approach. World J Gastroenterol 2014;20:11210-11215. [PMID: 25170205 PMCID: PMC4145759 DOI: 10.3748/wjg.v20.i32.11210] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/19/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open

Zhou Y, Zhang X, Wu L, Ye F, Su X, Li B. Evidence-based value of prophylactic intraperitoneal drainage following pancreatic resection: a meta-analysis. Pancreatology 2014;14:302-7. [PMID: 25062881 DOI: 10.1016/j.pan.2014.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 12/11/2022]

Razali RM, Bee PC, Gan GG. Survey of willingness to accept chemotherapy among elderly Malaysian patients. Asian Pac J Cancer Prev 2014;14:2029-32. [PMID: 23679313 DOI: 10.7314/apjcp.2013.14.3.2029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open

Lee DY, Schwartz JA, Wexelman B, Kirchoff D, Yang KC, Attiyeh F. Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg 2013;207:540-8. [PMID: 24560585 DOI: 10.1016/j.amjsurg.2013.07.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/18/2013] [Accepted: 07/06/2013] [Indexed: 01/03/2023]

Piciucchi M, Crippa S, Del Chiaro M, Valente R, Pezzilli R, Falconi M, Delle Fave G, Capurso G. Outcomes of intraductal papillary mucinous neoplasm with "Sendai-positive" criteria for resection undergoing non-operative management. Dig Liver Dis 2013;45:584-588. [PMID: 23453065 DOI: 10.1016/j.dld.2013.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 12/11/2022]