Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2017; 9(1): 30-36
Published online Jan 15, 2017. doi: 10.4251/wjgo.v9.i1.30
Pancreatic resection in very elderly patients: A critical analysis of existing evidence
Cosimo Sperti, Lucia Moletta, Gioia Pozza
Cosimo Sperti, Lucia Moletta, Gioia Pozza, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, 35128 Padua, Italy
Author contributions: Sperti C and Moletta L conceived the article and drafted the manuscript; Pozza G reviewed the Literature; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the Authors have no conflicts of interests to declare.
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:
Correspondence to: Cosimo Sperti, MD, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, via Giustiniani 2, 35128 Padova, Italy.
Telephone: +39-049-8218845 Fax: +39-049-8218821
Received: August 9, 2016
Peer-review started: August 10, 2016
First decision: September 12, 2016
Revised: September 19, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: January 15, 2017

The aging of the population results in a rise of number of elderly patients (aged 80 years and older) with pancreatic or periampullary cancer, and more pancreatectomies could eventually be performed in such complex patients. However, early and long-term results after pancreatic resection in octogenarians are still controversial, and may trouble the surgeon when approaching this type of population. Evaluation of reported experiences shows that for almost all Authors, pancreatectomy can be performed safely in elderly population, although overall morbidity and mortality rates were 34.9% and 13.2% respectively, with a mean length of hospital stay of 18 d. These features appear higher in older patients compared to the younger counterpart. Less than 50% of patients underwent adjuvant therapy after operation. Long-term survival is reported not significantly different in aged 80 years and older patients, with a median overall survival time of 17.6 mo. The quality of life after pancreatic resection is only sporadically evaluated but, when considered, it highlights the need of health facility service after operation for these “frail” patients. Prospective studies on the quality of life of pancreatectomized octogenarians are welcome. Proper selection of patients, geriatric assessment with multidisciplinary approach, centralization of pancreatic surgery in high-volume centres and rehabilitation programs after surgery appear to be crucial points in order to improve surgical treatments of pancreatic tumors in very elderly patients.

Keywords: Elderly, Octogenarian, Pancreatectomy, Pancreatic neoplasms, Survival

Core tip: Although not statistically significant, pancreatic resection in very older patients carried a greater risk of complications, mortality and nursing facility after discharge than in younger patients. Thus, pancreatectomy in 80 years and older patients, should be performed after careful consideration of potential benefit, surgical risk, and patient’s preferences.