Should Pancreaticoduodenectomy Be Performed in Octogenarians?

Taylor A. Sohn, Charles J. Yeo, John L. Cameron, Keith D. Lillemoe, Mark A. Talamini, Ralph H. Hruban, Patricia K. Sauter, JoAnn Coleman, Sarah E. Ord, Louise B. Grochow, Ross A. Abrams, Henry A. Pitt

Research output: Contribution to journalArticle

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Abstract

As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%), distal bile duct adenocarcinoma (n = 5; 11%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 454; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.

Original languageEnglish (US)
Pages (from-to)207-216
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume2
Issue number3
StatePublished - May 1998
Externally publishedYes

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Pancreaticoduodenectomy
Adenocarcinoma
Mortality
Cystadenocarcinoma
Cystadenoma
Morbidity
Survival
Chronic Pancreatitis
Operative Time
Bile Ducts
Length of Stay
Survival Rate

ASJC Scopus subject areas

  • Surgery

Cite this

Sohn, T. A., Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Talamini, M. A., Hruban, R. H., ... Pitt, H. A. (1998). Should Pancreaticoduodenectomy Be Performed in Octogenarians? Journal of Gastrointestinal Surgery, 2(3), 207-216.

Should Pancreaticoduodenectomy Be Performed in Octogenarians? / Sohn, Taylor A.; Yeo, Charles J.; Cameron, John L.; Lillemoe, Keith D.; Talamini, Mark A.; Hruban, Ralph H.; Sauter, Patricia K.; Coleman, JoAnn; Ord, Sarah E.; Grochow, Louise B.; Abrams, Ross A.; Pitt, Henry A.

In: Journal of Gastrointestinal Surgery, Vol. 2, No. 3, 05.1998, p. 207-216.

Research output: Contribution to journalArticle

Sohn, TA, Yeo, CJ, Cameron, JL, Lillemoe, KD, Talamini, MA, Hruban, RH, Sauter, PK, Coleman, J, Ord, SE, Grochow, LB, Abrams, RA & Pitt, HA 1998, 'Should Pancreaticoduodenectomy Be Performed in Octogenarians?', Journal of Gastrointestinal Surgery, vol. 2, no. 3, pp. 207-216.
Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH et al. Should Pancreaticoduodenectomy Be Performed in Octogenarians? Journal of Gastrointestinal Surgery. 1998 May;2(3):207-216.
Sohn, Taylor A. ; Yeo, Charles J. ; Cameron, John L. ; Lillemoe, Keith D. ; Talamini, Mark A. ; Hruban, Ralph H. ; Sauter, Patricia K. ; Coleman, JoAnn ; Ord, Sarah E. ; Grochow, Louise B. ; Abrams, Ross A. ; Pitt, Henry A. / Should Pancreaticoduodenectomy Be Performed in Octogenarians?. In: Journal of Gastrointestinal Surgery. 1998 ; Vol. 2, No. 3. pp. 207-216.
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abstract = "As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54{\%}), ampullary adenocarcinoma (n = 9; 20{\%}), distal bile duct adenocarcinoma (n = 5; 11{\%}), duodenal adenocarcinoma (n = 2; 4{\%}), cystadenocarcinoma (n = 2; 4{\%}), cystadenoma (n = 1; 2{\%}), and chronic pancreatitis (n = 2; 4{\%}). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57{\%} vs. 41{\%}; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3{\%} perioperative mortality rate compared to 1.6{\%} in the younger group (P = NS). In the subset of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19{\%}, compared to 20 months and 27{\%}, respectively, in patients younger than 80 years (n = 454; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.",
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