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Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 5/2009

01.09.2009 | Original article

A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age

verfasst von: Masaji Tani, Manabu Kawai, Seiko Hirono, Shinomi Ina, Motoki Miyazawa, Ryohei Nishioka, Atsushi Shimizu, Kazuhisa Uchiyama, Hiroki Yamaue

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 5/2009

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Abstract

Background

Although the mortality rates for pancreaticoduodenectomy have been reported to be low for periampullary tumors at high-volume centers, postoperative results still remain unclear for elderly patients over 80 years of age.

Methods

This was a retrospective study of patients who underwent a pancreaticoduodenectomy and consisted of 335 patients who were treated for periampullary tumors between January 1994 and August 2008. The main outcomes were postoperative complications, mortality, and the length of hospital stay among the elderly patients, and they were analyzed in three groups: elderly patients over 80 years old, septuagenarians, and those under 70 years of age.

Results

The performance status of elderly patients was lower than that of the patients under 70 (P < 0.05), and the elderly had a higher American Society of Anesthesiologists physical status classification score (P < 0.001) as well as low hemoglobin and serum albumin levels (P < 0.01 and P < 0.001, respectively). The incidence of delayed gastric emptying in the elderly was higher; however, there was no significant difference. The other outcomes in the elderly group were similar to those of the other groups.

Conclusions

Pancreaticoduodenectomy was considered to be a feasible surgical procedure for elderly patients who had a good performance status.
Literatur
1.
Zurück zum Zitat Kincannon CL. National bibliography of US government publications. Statistial Abstract of the United States: 2004–2005. Washington: US Census Bureau; 2005. Kincannon CL. National bibliography of US government publications. Statistial Abstract of the United States: 2004–2005. Washington: US Census Bureau; 2005.
2.
Zurück zum Zitat Ishikawa A, Beppu M, Sato R. Population statistics of Japan 2006. Yamato-sogo. Tokyo, Japan; 2006. Ishikawa A, Beppu M, Sato R. Population statistics of Japan 2006. Yamato-sogo. Tokyo, Japan; 2006.
3.
Zurück zum Zitat Etzioni D, Liu J, Maggard M, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–7.PubMed Etzioni D, Liu J, Maggard M, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–7.PubMed
4.
Zurück zum Zitat Lillemoe KD. Pancreatic and periampullary carcinoma in the elderly. Gastrointestinal surgery in the elderly. Probl Gen Surg. 1996;13:108–20. Lillemoe KD. Pancreatic and periampullary carcinoma in the elderly. Gastrointestinal surgery in the elderly. Probl Gen Surg. 1996;13:108–20.
5.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.PubMedCrossRef Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.PubMedCrossRef
6.
Zurück zum Zitat Suojaranta-Ylinen RT, Kuitunen AH, Kukkonen SI. Risk evaluation of cardiac surgery in octogenarians. J Cardiothorac Vasc Anesth. 2006;20:526–30.PubMedCrossRef Suojaranta-Ylinen RT, Kuitunen AH, Kukkonen SI. Risk evaluation of cardiac surgery in octogenarians. J Cardiothorac Vasc Anesth. 2006;20:526–30.PubMedCrossRef
7.
Zurück zum Zitat Vickers SM, Kerby JD, Smoot TM, Shumate CR, Halpern NB, Aldrete JS, et al. Economics of pancreaticoduodenectomy in the elerly. Surgery. 1996;120:620–6.PubMedCrossRef Vickers SM, Kerby JD, Smoot TM, Shumate CR, Halpern NB, Aldrete JS, et al. Economics of pancreaticoduodenectomy in the elerly. Surgery. 1996;120:620–6.PubMedCrossRef
8.
Zurück zum Zitat Dicarlo V, Balzano G, Zebri A, Villa E. Pancreatic cancer resection in elderly patients. Br J Surg. 1998;85:607–10.PubMedCrossRef Dicarlo V, Balzano G, Zebri A, Villa E. Pancreatic cancer resection in elderly patients. Br J Surg. 1998;85:607–10.PubMedCrossRef
9.
Zurück zum Zitat Bottger TC, Engelmann R, Junginger T. Is age a risk factor for major pancreatic surgery? An analysis of 300 resections. Hepatogastroenterol. 1999;46:2589–98. Bottger TC, Engelmann R, Junginger T. Is age a risk factor for major pancreatic surgery? An analysis of 300 resections. Hepatogastroenterol. 1999;46:2589–98.
10.
Zurück zum Zitat Bathe OF, Levi D, Caldera H, Franceschi D, Raez L, Patel A, et al. Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World J Surg. 2000;24:353–8.PubMedCrossRef Bathe OF, Levi D, Caldera H, Franceschi D, Raez L, Patel A, et al. Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World J Surg. 2000;24:353–8.PubMedCrossRef
11.
Zurück zum Zitat Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, et al. Pancreatic resection in the elderly. J Am Coll Surg. 2004;198:697–706.PubMedCrossRef Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, et al. Pancreatic resection in the elderly. J Am Coll Surg. 2004;198:697–706.PubMedCrossRef
12.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.PubMedCrossRef Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.PubMedCrossRef
13.
Zurück zum Zitat Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205:729–34.PubMedCrossRef Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205:729–34.PubMedCrossRef
14.
Zurück zum Zitat Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248:459–67.PubMed Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248:459–67.PubMed
15.
Zurück zum Zitat Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.PubMedCrossRef Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.PubMedCrossRef
16.
Zurück zum Zitat Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg. 2008;15:41–54.PubMedCrossRef Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg. 2008;15:41–54.PubMedCrossRef
17.
Zurück zum Zitat Kawai M, Uchiyama K, Tani M, Onishi H, Kinoshita H, Ueno M, et al. Clinicopathological features of malignant intraductal papillary mucinous tumors of the pancreas: the differential diagnosis from benign entities. Arch Surg. 2004;139:188–92.PubMedCrossRef Kawai M, Uchiyama K, Tani M, Onishi H, Kinoshita H, Ueno M, et al. Clinicopathological features of malignant intraductal papillary mucinous tumors of the pancreas: the differential diagnosis from benign entities. Arch Surg. 2004;139:188–92.PubMedCrossRef
18.
Zurück zum Zitat Kawarada Y, Isaji S. Modified standard (D1 + a) pancreaticoduodenectomy for pancreatic cancer. J Gastrointest Surg. 2000;4:227–8.PubMedCrossRef Kawarada Y, Isaji S. Modified standard (D1 + a) pancreaticoduodenectomy for pancreatic cancer. J Gastrointest Surg. 2000;4:227–8.PubMedCrossRef
19.
Zurück zum Zitat Tani M, Onishi H, Kinoshita H, Kawai M, Ueno M, Hama T, et al. The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg. 2005;29:76–9.PubMedCrossRef Tani M, Onishi H, Kinoshita H, Kawai M, Ueno M, Hama T, et al. The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg. 2005;29:76–9.PubMedCrossRef
20.
Zurück zum Zitat Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243:316–20.PubMedCrossRef Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243:316–20.PubMedCrossRef
21.
Zurück zum Zitat Tani M, Kawai M, Terasawa H, Ueno M, Hama T, Hirono S, et al. Complications with reconstruction procedures in pylorus-preserving pancreaticoduodenectomy. World J Surg. 2005;29:881–4.PubMedCrossRef Tani M, Kawai M, Terasawa H, Ueno M, Hama T, Hirono S, et al. Complications with reconstruction procedures in pylorus-preserving pancreaticoduodenectomy. World J Surg. 2005;29:881–4.PubMedCrossRef
22.
Zurück zum Zitat Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg. 2006;244:1–7.PubMedCrossRef Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg. 2006;244:1–7.PubMedCrossRef
23.
Zurück zum Zitat Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87:883–9.PubMedCrossRef Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87:883–9.PubMedCrossRef
24.
Zurück zum Zitat Neoptolemos JP, Russell RCG, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. Br J Surg. 1997;84:1370–6.PubMedCrossRef Neoptolemos JP, Russell RCG, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. Br J Surg. 1997;84:1370–6.PubMedCrossRef
25.
Zurück zum Zitat Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg. 2007;14:557–63.PubMedCrossRef Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg. 2007;14:557–63.PubMedCrossRef
26.
Zurück zum Zitat Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the pancreatic anastomotic leak study group. J Hepatobiliary Pancreat Surg. 2007;11:1451–9. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the pancreatic anastomotic leak study group. J Hepatobiliary Pancreat Surg. 2007;11:1451–9.
27.
Zurück zum Zitat Detsky AS, Baker JP, O’Rourke K, Johnston N, Whitwell J, Mendelson RA, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. J Parenter Enteral Nutr. 1987;11:440–6.CrossRef Detsky AS, Baker JP, O’Rourke K, Johnston N, Whitwell J, Mendelson RA, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. J Parenter Enteral Nutr. 1987;11:440–6.CrossRef
28.
Zurück zum Zitat Covinsky K, Martin G, Beyth RJ. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized patients. J Am Geriatr Soc. 1999;47:532–8.PubMed Covinsky K, Martin G, Beyth RJ. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized patients. J Am Geriatr Soc. 1999;47:532–8.PubMed
29.
Zurück zum Zitat Ament R. The expanding role of the American Society of Anesthesiologists. Anesthesiology. 1976;45:475–6.PubMedCrossRef Ament R. The expanding role of the American Society of Anesthesiologists. Anesthesiology. 1976;45:475–6.PubMedCrossRef
30.
Zurück zum Zitat Audisio R, Ramesh H, Longo W, Zbar A, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.PubMedCrossRef Audisio R, Ramesh H, Longo W, Zbar A, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.PubMedCrossRef
31.
Zurück zum Zitat Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg. 1999;6:303–11.PubMedCrossRef Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg. 1999;6:303–11.PubMedCrossRef
32.
Zurück zum Zitat Scurtu R, Bachellier P, Oussoultzoglow E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg. 2006;10:813–22.PubMedCrossRef Scurtu R, Bachellier P, Oussoultzoglow E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg. 2006;10:813–22.PubMedCrossRef
33.
Zurück zum Zitat Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.PubMedCrossRef Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.PubMedCrossRef
Metadaten
Titel
A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age
verfasst von
Masaji Tani
Manabu Kawai
Seiko Hirono
Shinomi Ina
Motoki Miyazawa
Ryohei Nishioka
Atsushi Shimizu
Kazuhisa Uchiyama
Hiroki Yamaue
Publikationsdatum
01.09.2009
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 5/2009
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0106-6

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