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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Salvatore Paiella, Matteo De Pastena, Tommaso Pollini, Giovanni Zancan, Debora Ciprani, Giulia De Marchi, Luca Landoni, Alessandro Esposito, Luca Casetti, Giuseppe Malleo, Giovanni Marchegiani, Massimiliano Tuveri, Enrico Marrano, Laura Maggino, Erica Secchettin, Deborah Bonamini, Claudio Bassi, Roberto Salvia
Salvatore Paiella, Matteo De Pastena, Tommaso Pollini, Giovanni Zancan, Debora Ciprani, Luca Landoni, Alessandro Esposito, Luca Casetti, Giuseppe Malleo, Giovanni Marchegiani, Massimiliano Tuveri, Enrico Marrano, Laura Maggino, Erica Secchettin, Deborah Bonamini, Claudio Bassi, Roberto Salvia, General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Giulia De Marchi, Gastroenterology B Department, Pancreas Institute, University and Hospital Trust of Verona, 37134 Verona, Italy
Author contributions: Paiella S, De Pastena M, Landoni L, Esposito A, Casetti L, Malleo G, Marchegiani G and Tuveri M designed the study; Pollini T, Zancan G, Ciprani D, Marrano E, Maggino L, Secchettin E and Bonamini D collected data; Paiella S, De Pastena M and Pollini T performed the statistics; Paiella S, De Pastena M, Pollini T, Zancan G and De Marchi G wrote the manuscript; Landoni L, Esposito A, Casetti L, Malleo G, Bassi C and Salvia R reviewed the manuscript.
Supported by Associazione Italiana Ricerca Cancro, AIRC No. 12182 and No. 17132; Italian Ministry of Health, No. FIMP-CUP_J33G13000210001; FP7 European Community Grant Cam-Pac, No. 602783.
Institutional review board statement: The study was reviewed and approved by the Local Ethics Committee (No. 1101 CESC).
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or are consultant/advisory board member for any organizations. None of the authors have received research funding from any organizations. None of the authors are employees of any organizations. None of the authors own stocks and/or share in any organizations. None of the authors own patents.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto Salvia, MD, PhD, General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134 Verona, Italy. roberto.salvia@univr.it
Telephone: +39-0458124816 Fax: +39-0458124826
Received: December 14, 2016
Peer-review started: December 16, 2016
First decision: January 19, 2017
Revised: January 20, 2017
Accepted: March 31, 2017
Article in press: March 31, 2017
Published online: May 7, 2017
AIM
To compare surgical and oncological outcomes after pancreaticoduodenectomy (PD) in patients ≥ 75 years of age with two younger cohorts of patients.
METHODS
The prospectively maintained Institutional database of pancreatic resection was queried for patients aged ≥ 75 years (late elderly, LE) submitted to PD for any disease from January 2010 to June 2015. We compared clinical, demographic and pathological features and survival outcomes of LE patients with 2 exact matched cohorts of younger patients [≥ 40 to 64 years of age (adults, A) and ≥ 65 to 74 years of age (young elderly, YE)] submitted to PD, according to selected variables.
RESULTS
The final LE population, as well as the control groups, were made of 96 subjects. Up to 71% of patients was operated on for a periampullary malignancy and pancreatic cancer (PDAC) accounted for 79% of them. Intraoperative data (estimated blood loss and duration of surgery) did not differ among the groups. The overall complication rate was 65.6%, 61.5% and 58.3% for LE, YE and A patients, respectively, P = NS). Reoperation and cardiovascular complications were significantly more frequent in LE than in YE and A groups (P = 0.003 and P = 0.019, respectively). When considering either all malignancies and PDAC only, the three groups did not differ in survival. Considering all benign diseases, the estimated mean survival was 58 and 78 mo for ≥ and < 75 years of age (YE + A groups), respectively (P = 0.012).
CONCLUSION
Age is not a contraindication for PD. A careful selection of LE patients allows to obtain good surgical and oncological results.
Core tip: Age ≥ 75 years is not a contraindication for pancreaticoduodenectomy. The selection of patients is of utmost importance to obtain the best surgical and oncological results. Our analysis demonstrated that post-operative results are similar in patients aged ≥ and < 75 years of age.
