Abstract
Background
During the last century, life expectancy has doubled. As a result, senior patients
with cancer are more frequently referred for possible surgery. Pancreatic surgery
is a complex surgery associated with significant postoperative morbidity. Surgical
decision-making in the elderly population can be difficult because outcomes in the
elderly are poorly defined. Our objective is to characterize differences in mortality
and morbidity for pancreatic surgery in the elderly population.
Methods
A retrospective review of all patients undergoing pancreatic head surgery in our tertiary
referral center from 2015 to 2021 was conducted. Analysis was performed for the entire
cohort, classifying patients into three age groups: <70 years, 70–79 years, and ≥80
years. Data from these three groups were compared, including comorbidity, oncologic
outcomes and postoperative complications.
Results
A total of 326 patients underwent pancreatic head resection. The 90-day mortality
increased from 2.9% to 5.3% to 15.4% with increasing age (p = 0,015). There were no
differences among the three groups in terms of postoperative morbidity. There was
no difference in disease-free survival (DFS), but overall survival was better in patients
under 70 years (p = 0,046).
Conclusion
Compared to younger patients, patients over 80 years old have a higher risk of mortality
despite similar postoperative morbidity.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to HPBAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Population Bulletin.Popul Bull. 2015; 23
- Population ageing in the United Kingdom, its constituent countries and the European Union. Office for National Statistics, 2012 (Disponible sur:)
- The aging population and its impact on the surgery workforce.Ann Surg. 2003; 238 (Internet) (Disponible sur:)
- Frailty in the older surgical patient: a review.Age Ageing. 2012; 41: 142-147
- Enrollment of older patients in cancer treatment trials in Canada: why is age a barrier?.J Clin Oncol. 2003; 21: 1618-1623
Office UCBPI. U.S. Census bureau projections show a slower growing, older, more diverse nation a half century from now. Population - Newsroom - U.S. Census Bureau. [Internet]. [cité 29 nov 2022]. Disponible sur: https://www.census.gov/newsroom/releases/archives/population/cb12-243.html.
- One thousand consecutive pancreaticoduodenectomies and beyond: a personal series.Am J Surg. 2007; 194: S11-S15
- Surgical treatment of pancreatic cancer.Pol Przegl Chir. 30 avr 2018; 90: 45-53
- The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): cross sectional study.Int J Surg. avr 2018; 52: 383-387
- A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy.J Surg Res. 2015; 193: 237-245
- Pancreaticoduodenectomy (whipple operation).Surg Oncol Clin N Am. 2005; 14: 533-552
- Surgical considerations in older adults with cancer.J Clin Oncol. 20 août 2014; 32: 2647-2653
- Lung surgery in the elderly today.Lung Cancer. 2013; 80: 115-119
- Ovarian cancer in the elderly: impact of surgery on morbidity and survival.Eur J Surg Oncol. 2011; 37: 537-542
- Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old.Ann Surg. mai 2011; 253: 947-952
- Surgical care in octogenarians.Br J Surg. 1996; 83: 1783-1787
- Managing elderly soft tissue sarcoma patients—should age drive treatment?.Ann Surg Oncol. 2010; 17: 1725-1726
- Complete soft tissue sarcoma resection is a viable treatment option for select elderly patients.Ann Surg Oncol. 2009; 16: 2579-2586
- Laparoscopic nephrectomy in young-old, old-old, and oldest-old adults.J Gerontol Ser A. 2001; 56M287-91
- Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review.Aging Clin Exp Res. févr 2017; 29: 55-63
- The outcomes of the elderly in acute care general surgery.Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc. févr 2016; 42: 107-113
- Predicting adverse postoperative outcomes in patients aged 80 years or older.J Am Geriatr Soc. avr 2000; 48: 405-412
- Grading of patients for surgical procedures.Anesthesiology. 1941; 2: 281-284
- The effect of age on short-term outcomes after pancreatic resection: a population-based study.Ann Surg. sept 2008; 248: 459-467
- Pancreaticoduodenectomy in the very elderly.J Gastrointest Surg Off J Soc Surg Aliment Tract. mars 2006; 10: 347-356
- Improving the care of elderly adults undergoing surgery in Michigan.J Am Geriatr Soc. févr 2014; 62: 352-357
- Improving mortality following emergent surgery in older patients requires focus on complication rescue.Ann Surg. oct 2013; 258 (; discussion 617-618): 614-617
- The importance of immediate total-body CT scanning.The Lancet. 4 févr 2017; 389: 502-503
- Outcomes in elderly patients following surgery for colorectal cancer in the veterans affairs health care system.Aliment Pharmacol Ther. 2004; 20: 1115-1124
- Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients.Chest. mars 2005; 127: 886-891
- Quality of life and outcomes after pancreaticoduodenectomy.Ann Surg. juin 2000; 231: 890-898
- Aging, disability and frailty.Ann Nutr Metab. 2008; 52: 6-11
- Peri-operative care of elderly patients – an urgent need for change: a consensus statement to provide guidance for specialist and non-specialist anaesthetists.Perioper Med. 27 mars 2013; 2: 6
- Preoperative frailty evaluation: a promising risk-stratification tool in older adults undergoing general surgery.Clin Ther. mars 2019; 41: 387-399
Article info
Publication history
Published online: January 19, 2023
Accepted:
December 31,
2022
Received:
August 30,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
