2005 Abstracts: Outcomes of Pancreaticoduodenectomy Among Octogenarians, Nonagenarians, and a Centenarian
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Outcomes of Pancreaticoduodenectomy Among Octogenarians, Nonagenarians, and a Centenarian
Martin A. Makary, Jordan Winter, John L. Cameron, Kurtis A. Campbell, Steven C. Cunningham, David Chang, Taylor S. Riall, Charles J. Yeo, Johns Hopkins University, Baltimore, MD
Background: It is estimated that by the year 2050, there will be a 300% increase in the elderly population, with a corresponding increase in elderly patients presenting for surgical evaluation. Surgical decision-making in this population remains controversial because outcomes in the elderly are poorly defined.
Methods: We reviewed 2182 consecutive pancreaticoduodenectomies (PD) at our institution over a 34-year period between April 1970 and October 2004, with the last 1000 resections being done in the last 4 yrs. Data collected included mortality (defined as 30-day or in-hospital mortality), complications, surgical indication, and short and long-term survival. Patients were divided by age into three groups (≤79, 80-89, and ≥90 years) and compared using a chi-square test. A simple logistic regression model with pseudo r2 analysis was used to determine the overall meaningfulness of age as an independent contributor to the outcome of death or a complication. Results: 197 patients 80 years of age or older underwent a PD (9% of 2182). Patients 80-89 years of age had a mortality rate of 4.3% (8/187) and a complication rate of 52.9% (99/187), results which were greater than patients ≤79 years of age (mortality=1.9%, complication rate=43.6%, p<0.05). There were no perioperative deaths among the ten patients 90 years of age or older, and their complication rate was 50% (5/10). The likelihood that a malignancy was present increased with age (≤79 years=77%; 80-89 years=86%; and ≥90 years=100%). One-year survival was 52% for patients 80-89 years of age and 70% for patients 90 years of age and older. The only centenarian (103 years old) had no complications and a postoperative survival of 1.5 years. Using logistic regression modeling with pseudo r2 analysis, we found that age contributed less than 1% to the outcome of death (pseudo r2=0.006) or a complication (pseudo r2=0.004). Conclusion: While age has a relationship to death and complications following PD, the contribution is very minor. We demonstrate that PD can be safely performed in the very elderly and conclude that age alone should not be a contraindication to pancreatic resection. The advent of improved surgical outcomes in the context of an increasing elderly population likely will result in a significant increase in the number of PDs performed in the next few decades.
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