Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified?

Saboor Khan, Guido Sclabas, Kaye Reid Lombardo, Michael G. Sarr, David Nagorney, Michael L. Kendrick, John H. Donohue, Florencia Que, Michael B. Farnell

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age. Methods: All patients who underwent PD for pancreatic adenocarcinoma from 1981 to 2007 were analyzed for perioperative outcomes, tumor-related parameters, use of adjuvant therapy, and long-term survival. Specifically those aged ≥80 years were compared with a control group aged ≤80 years. Continuous variables are displayed as median and interquartile range (IQR); log-rank test and Cox's proportional hazards were used to determine survival and effect of age as an independent marker against other covariates. Results: Fifty-three patients aged ≥80 years underwent PD. Twenty-six (51%) developed complications, including delayed gastric emptying (nine, 17%), pancreatic leak (six, 11%), and postoperative bleeding (five, 9%). There was one in-hospital death (2%). The hospital stay was 13.5 days (IQR 9-19). Forty-one (79%) patients were discharged home; of the 11 (21%) patients who went to an outside health care facility (pancreatic leak/drains and feeding issues-five, delayed gastric emptying/nutritional-four, no home support-one), one died in a nursing home at 5 months while the other ten patients returned to their previous abode (median 4 weeks). The median disease-free and overall survivals were 11.8 (IQR 7.8-18.4) and 13.5 months (IQR 12-21.3). Compared to the non-octogenarians (n = 567), the older population had more poor risk patients with respect to ASA status (P < 0.0004), stayed longer as in-patients (P < 0.04), were more likely to develop complications (P < 0.001), and were less likely to receive adjuvant therapy (P < 0.0001). There was no difference in long-term disease-free or overall survival (log-rank P < 0.30 and P < 0.14), and age did not appear to be an independent marker of prognosis when analyzed (Cox's proportional hazards P < 0.26; chi-square, 1.25). Conclusions: In experienced institutions, PD for ductal adenocarcinoma is a viable option in the ambulatory octogenarian population who are deemed operative candidates for a PD. The trade off is a greater complication rate and the prospect of discharge (one in five) to a chronic care facility. The majority, however, can be discharged home with a reasonable functional status, and those discharged to temporary health care rehabilitation facilities are likely to make a recovery over a few weeks.

Original languageEnglish (US)
Pages (from-to)1826-1831
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume14
Issue number11
DOIs
StatePublished - 2010

Fingerprint

Pancreaticoduodenectomy
Adenocarcinoma
Gastric Emptying
Survival
Population
Delivery of Health Care
Health Facilities
Nursing Homes
Pancreatic Neoplasms
Disease-Free Survival
Length of Stay
Rehabilitation
Hemorrhage
Morbidity
Control Groups
Incidence
Therapeutics

Keywords

  • Operative risks
  • Pancreatic cancer
  • Pancreatic surgery
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Khan, S., Sclabas, G., Lombardo, K. R., Sarr, M. G., Nagorney, D., Kendrick, M. L., ... Farnell, M. B. (2010). Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified? Journal of Gastrointestinal Surgery, 14(11), 1826-1831. https://doi.org/10.1007/s11605-010-1294-8

Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified? / Khan, Saboor; Sclabas, Guido; Lombardo, Kaye Reid; Sarr, Michael G.; Nagorney, David; Kendrick, Michael L.; Donohue, John H.; Que, Florencia; Farnell, Michael B.

In: Journal of Gastrointestinal Surgery, Vol. 14, No. 11, 2010, p. 1826-1831.

Research output: Contribution to journalArticle

Khan, S, Sclabas, G, Lombardo, KR, Sarr, MG, Nagorney, D, Kendrick, ML, Donohue, JH, Que, F & Farnell, MB 2010, 'Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified?', Journal of Gastrointestinal Surgery, vol. 14, no. 11, pp. 1826-1831. https://doi.org/10.1007/s11605-010-1294-8
Khan, Saboor ; Sclabas, Guido ; Lombardo, Kaye Reid ; Sarr, Michael G. ; Nagorney, David ; Kendrick, Michael L. ; Donohue, John H. ; Que, Florencia ; Farnell, Michael B. / Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified?. In: Journal of Gastrointestinal Surgery. 2010 ; Vol. 14, No. 11. pp. 1826-1831.
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abstract = "Background: The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age. Methods: All patients who underwent PD for pancreatic adenocarcinoma from 1981 to 2007 were analyzed for perioperative outcomes, tumor-related parameters, use of adjuvant therapy, and long-term survival. Specifically those aged ≥80 years were compared with a control group aged ≤80 years. Continuous variables are displayed as median and interquartile range (IQR); log-rank test and Cox's proportional hazards were used to determine survival and effect of age as an independent marker against other covariates. Results: Fifty-three patients aged ≥80 years underwent PD. Twenty-six (51{\%}) developed complications, including delayed gastric emptying (nine, 17{\%}), pancreatic leak (six, 11{\%}), and postoperative bleeding (five, 9{\%}). There was one in-hospital death (2{\%}). The hospital stay was 13.5 days (IQR 9-19). Forty-one (79{\%}) patients were discharged home; of the 11 (21{\%}) patients who went to an outside health care facility (pancreatic leak/drains and feeding issues-five, delayed gastric emptying/nutritional-four, no home support-one), one died in a nursing home at 5 months while the other ten patients returned to their previous abode (median 4 weeks). The median disease-free and overall survivals were 11.8 (IQR 7.8-18.4) and 13.5 months (IQR 12-21.3). Compared to the non-octogenarians (n = 567), the older population had more poor risk patients with respect to ASA status (P < 0.0004), stayed longer as in-patients (P < 0.04), were more likely to develop complications (P < 0.001), and were less likely to receive adjuvant therapy (P < 0.0001). There was no difference in long-term disease-free or overall survival (log-rank P < 0.30 and P < 0.14), and age did not appear to be an independent marker of prognosis when analyzed (Cox's proportional hazards P < 0.26; chi-square, 1.25). Conclusions: In experienced institutions, PD for ductal adenocarcinoma is a viable option in the ambulatory octogenarian population who are deemed operative candidates for a PD. The trade off is a greater complication rate and the prospect of discharge (one in five) to a chronic care facility. The majority, however, can be discharged home with a reasonable functional status, and those discharged to temporary health care rehabilitation facilities are likely to make a recovery over a few weeks.",
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AU - Khan, Saboor

AU - Sclabas, Guido

AU - Lombardo, Kaye Reid

AU - Sarr, Michael G.

AU - Nagorney, David

AU - Kendrick, Michael L.

AU - Donohue, John H.

AU - Que, Florencia

AU - Farnell, Michael B.

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N2 - Background: The outcomes of complex major surgery in the elderly are being scrutinized because of the demands on surgical services by an aging population and the concern whether such endeavors are justified. Pancreatoduodenectomy (PD) for pancreatic adenocarcinoma presents special challenges because of the high morbidity of the procedure, dismal prognosis of the disease, and the increasing incidence of pancreatic cancer with age. Methods: All patients who underwent PD for pancreatic adenocarcinoma from 1981 to 2007 were analyzed for perioperative outcomes, tumor-related parameters, use of adjuvant therapy, and long-term survival. Specifically those aged ≥80 years were compared with a control group aged ≤80 years. Continuous variables are displayed as median and interquartile range (IQR); log-rank test and Cox's proportional hazards were used to determine survival and effect of age as an independent marker against other covariates. Results: Fifty-three patients aged ≥80 years underwent PD. Twenty-six (51%) developed complications, including delayed gastric emptying (nine, 17%), pancreatic leak (six, 11%), and postoperative bleeding (five, 9%). There was one in-hospital death (2%). The hospital stay was 13.5 days (IQR 9-19). Forty-one (79%) patients were discharged home; of the 11 (21%) patients who went to an outside health care facility (pancreatic leak/drains and feeding issues-five, delayed gastric emptying/nutritional-four, no home support-one), one died in a nursing home at 5 months while the other ten patients returned to their previous abode (median 4 weeks). The median disease-free and overall survivals were 11.8 (IQR 7.8-18.4) and 13.5 months (IQR 12-21.3). Compared to the non-octogenarians (n = 567), the older population had more poor risk patients with respect to ASA status (P < 0.0004), stayed longer as in-patients (P < 0.04), were more likely to develop complications (P < 0.001), and were less likely to receive adjuvant therapy (P < 0.0001). There was no difference in long-term disease-free or overall survival (log-rank P < 0.30 and P < 0.14), and age did not appear to be an independent marker of prognosis when analyzed (Cox's proportional hazards P < 0.26; chi-square, 1.25). Conclusions: In experienced institutions, PD for ductal adenocarcinoma is a viable option in the ambulatory octogenarian population who are deemed operative candidates for a PD. The trade off is a greater complication rate and the prospect of discharge (one in five) to a chronic care facility. The majority, however, can be discharged home with a reasonable functional status, and those discharged to temporary health care rehabilitation facilities are likely to make a recovery over a few weeks.

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