 |
|
Surgical Treatment of Pancreatic Head Carcinoma in Elderly Patients
Stefania Brozzetti, MD;
Gianluca Mazzoni, MD, PhD;
Michelangelo Miccini, MD;
Francesco Puma, MD;
Monica De Angelis, MD;
Diletta Cassini, MD;
Elia Bettelli, MD;
Adriano Tocchi, MD;
Antonino Cavallaro, MD
Arch Surg. 2006;141:137-142.
Hypothesis The treatment of cancer in elderly patients has become a global clinical issue, considering the increasingly longer life expectancy. Three quarters of patients with pancreatic adenocarcinoma are older than 60 years. Surgical resection is the only chance of cure, and early outcome of pancreaticoduodenectomy in elderly patients is comparable with that obtained in a younger population.
Design During an 11-year period, 166 patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. Clinical and demographic factors were evaluated by univariate and multivariate analyses to test their effect on early outcome.
Setting State university medical school tertiary care center.
Patients One hundred sixty-six patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. They were divided into 2 groups according to age (group A for patients older than 70 years, group B for patients younger than 70 years).
Intervention Pancreaticoduodenectomy was performed using a Whipple procedure. An end-to-end pancreaticojejunostomy was constructed. Lymphadenectomy was carried out along the hepatoduodenal ligament, common hepatic artery, vena cava, superior mesenteric vein, and along the right side of the superior mesenteric artery. Four abdominal drainage sites were routinely used.
Main Outcome Measures The postoperative hospital stay was calculated and morbidity and mortality were assessed.
Results Significantly higher operative morbidity and mortality were observed in group A (group A, 49.1% vs group B, 45.8% and 10.5% vs 3.7%, respectively). Underlying comorbid conditions in group B patients influenced postoperative morbidity but not mortality. Rate and nature of surgical complications were indicated as causes of significant higher mortality in group B patients.
Conclusions An aggressive surgical approach is justified for elderly patients with pancreatic adenocarcinoma. However, surgical complications that lead to reoperation are responsible for a high mortality in elderly patients. In addition to general causes, such as concomitant disorders, reduced functional reserve, poor tolerance to stress, and the texture of the pancreatic remnant, there are specific prognostic factors affecting pancreaticojejunostomy leakage and related mortality.
Author Affiliations: Department of Surgery, University of Rome "La Sapienza" Medical School, Rome, Italy (Drs Brozzetti, Mazzoni, Miccini, De Angelis, Cassini, Bettelli, Tocchi, and Cavallaro); Department of General and Thoracic Surgery, University of Perugia Medical School, Perugia, Italy (Dr Puma).
|
