Outcomes of Pancreatic Resections in the Elderly and Geriatric Patients

Czech version

Authors: R. Svatoň; M. Man; Z. Kala; V. Procházka; J. Hlavsa; I. Penka
Authors‘ workplace: Chirurgická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno-Bohunice přednosta: prof. MUDr. Zdeněk Kala, CSc.
Published in: Rozhl. Chir., 2008, roč. 87, č. 10, s. 521-526.
Category: Monothematic special - Original

Overview

As a result of the population aging, we are confronted with the problematics of geriatric patients more and more frequently. The aim of this retrospective study was to compare outcomes of pancreatic resections in patients of three different age groups.

During 2000–2007, 150 pancreatic resections were performed in our clinic, including 34 (22.7%) patients aged 65 and over at the time of the procedure and 5 (3.3%) patients over 75 y.o.a. The procedures were heterogenous, including indications for oncologic diagnoses, as well as for chronic pancreatitis.

Our assessment demonstrated no significant differences in the 30-day postoperative mortality between the group of subjects over 65 y.o.a, geriatric group (i.e. over 75 y.o.a) and the group of subjects below 54 y.o.a. (8.8% vs. 0% vs. 5.2%). Furthermore, the postoperative morbidity showed no statistically significant differences between the all three groups (30.2% vs. 29.4% vs. 20%). The commonest postoperative complications included secondary healing of the surgical wound (7.8%) and pancreatic fistules (6.9%) in the group of subjects below 65 y.o.a., and insufficiency of the pancreatic-jejunal anastomosis (5.8%) and hepatic- jejunal anastomosis (5.88%) in the group aged 65 and over.Pancreatic-jejunal anastomosis insufficiency, complicated by consecutive bleeding, contributed to postoperative mortality most significantly. Significant increase in postoperative complication rates connected to proximal pancreatoduodenectomies and total pancreatoduodenectomies, was recorded in patients over 65, compared to those in the young patient group (p = 0.014). No statistically significant relation was found between a particular comorbidity and onset of postoperative complications or deaths in patients over 65 or geriatric patients.

Based on the results, the authors do not consider the patient’s age a contraindication for pancreatic resection procedures. Radical resections can be performed with acceptable mortality and morbidity rates in geriatric patients.

Key words:
resection – pancreas – geriatric patient

Sources

1. Czech republic: age distribution by sex and age group in 2006 (on line) 8. 6. 2007. Dostupný na WWW:

http://www.czso.cz/csu/2007edicniplan.nsf/t/F400409B4E/$File/400307001.pdf

2. Věkové složení obyvatelstva podle pětiletých věkových skupin, obě pohlaví. (on line) 17. 12. 2003. Dostupný na WWW: http://www.czso.cz/csu/2003edicniplan.nsf/t/FF004FBA8E/$File/4020rr09.pdf

3. Dítě, P., Starý, K., Novotný, I., et al. The Incidence of chronic pancreatitis in Czech Republic. Europ. J. Gastroenterol. Hepatol., 2001, 13, 749–750.

4. Shore, S., Vimalachandran, D., Raraty, M. G., Ghaneh, P. Cancer in the elderly: pancreatic cancer. Surgical Oncology, 13(4): 201–210, 2004 Dec.

5. Casadei, R., Zanini, N., Morselli-Labate, A. M., Calculli, L., Pezzilli, R., Poti, O., Grottola, T., Ricci, C., Minni, F. Prognostic factors in periampullary and pancreatic tumor resection in elderly patients. World Journal of Surgery, 30(11): 1992–2001; discussion 2002-2003, 2006 Nov.

6. Hannoun, L., Christophe, M., Ribeiro, J., Nordlinger, B., Elriwini, M., Tiret, E., Parc, R. A report of forty-four instances of pancreaticoduodenal resection in patients more than seventy years of age. Surgery, Gynecology & Obstetrics. 177(6): 556–560, 1993 Dec.

7. Fong, Y., Blumgart, L. H., Fortner, J. G., Brennan, M. F. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Annals of Surgery, 222(4): 426–434; discussion 434–437, 1995 Oct.

8. Herter, F. P., Cooperman, A. M., Ahlborn, T. N., Antinori, C. Surgical experience with pancreatic and periampullary cancer. Annals of Surgery, 195(3): 274–281, 1982 Mar.

9. Lerut, J. P., Gianello, P. R., Otte, J. B., Kestens, P. J. Pancreaticoduodenal resection. Surgical experience and evaluation of risk factors in 103 patients. Annals of Surgery, 199(4): 432–437, 1984 Apr.

10. Brozzetti, S., Mazzoni, G., Miccini, M., Puma, F., De Angelis, M., Cassini, D., Bettelli, E., Tocchi, A., Cavallaro, A. Surgical Treatment of Pancreatic Head Carcinoma in Elderly Patients. Archives of Surgery, 141(2): 137–142, February 2006.

11. Lightner, A. M., Glasgow, R. E., Jordan, T. H., Krassner, A. D., Way, L. W., Mulvihill, S. J., Kirkwood, K. S. Pancreatic resection in the elderly. Journal of the American College of Surgeons, 198(5):697–706, 2004 May.

12. Sohn, T. A., Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Talamini, M. A., Hruban, R. H., Sauter, P. K., Coleman, J., Ord, S. E., Grochow, L. B., Abrams, R. A., Pitt, H. A. Should pan-creaticoduodenectomy be performed in octogenarians? Journal of Gastrointestinal Surgery, 2(3): 207–216, 1998 May-Jun.

13. Chen, J. W., Shyr, Y. M., Su, C. H. Wu, C. W., Lui, W. Y. Is pancreaticoduodenectomy justified for septuagenarians and octogenarians? Hepato-Gastroenterology, 50(53): 1661–1664, 2003 Sep-Oct.

14. Bathe, O. F., Levi, D., Caldera, H., Franceschi, D., Raez, L., Patel, A., Raub, W. A. Jr., Benedetto, P., Reddy, R., Hutson, D., Sleeman, D., Livingstone, A. S., Levi, J. U. Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World Journal of Surgery, 24(3): 353–358, 2000 Mar.

15. Kairaluoma, M. I., Stahlberg, M., Kiviniemi, H. Pancreatic resection for carcinoma of the pancreas and the periampullary region. A twenty-year experience. HPB Surgery, 2(1): 57–66; discussion 66–67, 1990 Mar.

16. Vickers, S. M., Kerby, J. D., Smoot, T. M., Shumate, C. R., Halpern, N. B., Aldrete, J. S., Gleysteen, J. J. Economics of pan- creatoduodenectomy in the elderly. Surgery, 120(4): 620–625; discussion 625–626, 1996 Oct.