Clinical Science
Is a surgical approach justified for octogenarians with pancreatic carcinoma? Projecting surgical decision making for octogenarian patients

https://doi.org/10.1016/j.amjsurg.2015.12.033Get rights and content

Highlights

  • This journal feature begins with vignette highlighting clinical problems of a surgical approach justified for octogenarians with pancreatic carcinoma.

  • Overall survival was similar between the groups (30 vs 26 months, P = .9).

  • There were no significant differences in postoperative severe complication rates for younger and octogenarian groups (16% vs 20%, respectively, P = .5) or perioperative mortality rates (1.3% vs .0%, P = 1.0), but the incidence of postoperative delirium in the octogenarian group was greater than that in the younger group (23.5% vs 3.8%).

  • Evidence supporting various strategies is then presented.

  • The author ends with the author's clinical recommendations: octogenarian pancreatic cancer patients should not be denied a priori the opportunity for surgery, their only chance of cure, particularly if the patient represents an ideal candidate and if the co-operation of the family can be obtained.

Abstract

Background

In recent years, more elderly patients have undergone surgery for pancreatic cancer, although the safety and efficacy of performing complex pancreatic resections in patients older than 80 years remain controversial.

Methods

Patients with pancreatic cancer who underwent curative surgical treatment were divided into 2 subgroups: the younger group (<80 years) and the octogenarian group (≥80 years).

Results

From March 2005 to December 2013, 194 consecutive surgically curable patients with diagnosed pancreatic cancer were studied, among which 34 (17.5%) were of 80 years or older. There were no significant differences in postoperative severe complication rates for younger and octogenarian groups (16% vs 20%, respectively) or perioperative mortality rates (1.3% vs .0%). The incidence of postoperative delirium in the octogenarian group was greater than that in the younger group (23.5% vs 3.8%).

Conclusions

Octogenarian pancreatic cancer patients should not be denied a priori the opportunity for surgery, particularly if the patient represents an ideal candidate and if the co-operation of the family can be obtained.

Section snippets

Patients

The diagnosis of pancreatic cancer was made initially after imaging and then confirmed by pathologic analysis. We retrospectively reviewed the surgical pathology database of the Kochi Health Sciences Center to identify patients who underwent resection for pancreatic neoplasms from March 2005 to December 2013. Clinical characteristics evaluated included age, sex, part of the tumor, tumor size, surgical procedures undertaken, and pathologic data. The Eastern Cooperative Oncology Group (ECOG)

Results

From March 2005 to December 2013, 194 consecutive patients with newly diagnosed, surgically curable pancreatic cancer were managed in the Department of Gastroenterological Surgery at Kochi Health Sciences Center. Preoperative characteristics are detailed in Table 1. Of these patients, 100 were men and 94 were women, ranging in age from 34 to 88 years (mean 70.2 years), with 34 patients (17.5%) aged 80 years or older. The mean age in the octogenarian group (83.1 ± 2.3 years; range 80 to 88) was

Comments

The overall survival curves were virtually identical in this study of pancreatic cancer patients in those younger than and older than 80 years, and no statistically significant disadvantage in 3- and 5-year disease-free survival was observed between the octogenarian and younger groups. Furthermore, excellent curative treatment was achieved by surgical resection for octogenarian patients with pancreatic cancer, with zero mortality in the octogenarian group and no significant increase in

Acknowledgment

This work was supported by Kochi Organization for Medical Reformation and Renewal grants.

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    The authors declare no conflicts of interest.

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