Article
Elderly patients still need a cure? – An analyse of pancreaticoduodenectomy in patients 75 years and older
Search Medline for
Authors
-
J. Li
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Ingmar Königsrainer
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Kasimir Müller
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Ruth Ladurna
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Maria Witte
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Alfred Königsrainer
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
-
Silvio Nadalin
- Universitätsklinikum Tübingen, Universitätsklinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen
| Published: | May 20, 2011 |
|---|
Outline
Text
Introduction: In elderly patients with age of 75 years and older, whether the benefit of pancreaticoduodenectomy overweights the postoperative morbidity and mortality is unknown.
Materials and methods: From January 2005 to September 2010, 30 elderly patients underwent curative pancreaticoduodenectomy for neoplasia as the preoperative diagnosis. The preoperative co-morbidities, operative time, histology of the specimen, hospital stay, 30 day morbidity and mortality were reviewed.
Results: The patients included 14 men and 16 women, with median age of 77 years. 16 of them had at least two co-morbidities (cardiac, pulmonary, renal diseases, diabetes mellitus).
Within the 30 pancreaticoduodenectomies, 24 were Pylorus-preserving pancreaticoduodenectomy. Vascular reconstruction was performed in 4 patients. The median operative time was 330 (range: 236 to 573) minutes.
The final histology of the specimen identified non-malignant disease in 8 patients. Local advanced disease with tumor staging as pT3 or pT4 was found in 90% (20/22) of the patients with malignancy. R0 status was achieved in 82% (18/22).
The over-all morbidity was 57% (17/30). 24% of them (n=4) were non-surgical complications. Delayed gastric empty was found in 6 patients (20%). Pancreas fistula was found in 3 patients (10%). The surgical complications were classified as mild in 5, moderate in 3, severe in 5 according to the Accordion Severity Grading System. The 30-day mortality was 3% (1/30). The median ICU-stay was 3 days and the median postoperative hospital stay was 15 days.
Conclusion: Despite of increased co-morbidities and more local advanced disease, pancreaticoduodenectomy can be performed safely in elderly patients with equivalent rate of sever morbidity and mortality as for the younger population reported. The complete removal of the diseased organs in all patients with non-malignant disease and 84% R0 resection in patients with malignant disease also encourage keeping the pancreaticoduodenectomy as a fundamental therapy option in elderly patients.
