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Background: Major pancreatectomies are increasingly being performed in octogenarian (≥80 y) patients with reported clinical outcomes from large-volume medical centers. In this study we analyzed the outcomes of pancreatic resections in octogenarians at our community-based institution.
Methods: A retrospective chart review of 148 patients undergoing pancreatic resections by a single surgeon (A.Y.) between 2006 and 2010 was performed. Data was collected for demographics, clinical presentation, perioperative course, histology, and survival. We compared patients who were older and younger than 80 years with statistical significance of p<0.05. Survival analysis was performed using the Kaplan-Meier method.
Results: Twenty-four patients ≥80 y old underwent pancreatectomies (n=24, range 80-90y) compared to 124 patients <80 y (n=124, range 26-79y). The two groups were similar in the distribution of their clinical characteristics, including ASA class. Pancreaticoduodenectomy (PD) was the most common procedure performed in the two groups (≥80y n=16, 67%; <80y n=83, 67%; p=0.98). There were no significant differences between the older and younger patients in respect to the operative time (228 vs. 245 min, p=0.09), perioperative blood transfusions (33% vs. 27%, p=0.56), Clavien grade I and II complications (46% vs. 43%, p=0.84), Clavien grade III and IV complications (21% vs. 21%, p=0.99), clinically significant fistulas (21% vs. 14%, p=0.43), and perioperative mortalities (8% vs. 5%, p= 0.49). Malignancy had a higher incidence in the older group (87% vs. 62%, p= 0.02). The median length of hospital stay was also significantly higher in ≥80 y patients (14 vs. 9 days, p=0.03). Although survival was significantly less in the octogenarian group for all pathologies (p=0.04), notably, for pancreatic cancer patients, one and two year survival outcomes were similar (p= 0.25).
Conclusion: Major pancreatic resections can safely be performed in octogenarians in a community-based hospital with similar perioperative outcomes to younger patients. Comparable survival outcomes can be achieved in octogenarians when surgery is limited to malignant indications.

Patient characteristics and histopathology

	≥80 years (n=24)	<80 years (n=124)	P-value
Age (years)	83 (80 - 90 y)	67 (26 - 79)
Female	16 (67%)	47 (38%)	0.01
ASA class ≥3	10 (59%)	47 (46%)	0.35
Cardiovascular comorbidity	17 (71%	78 (63%)	0.46
Diabetes Mellitus	5 (21%)	35 (28%)	0.46
Preoperative ERCP	5 (21%)	18 (14%)	0.43
Histopathology
Pancreatic carcinoma	21 (87%)	77 (62%)	0.02
Neuroendocrine tumor	2 (8.3%)	11 (8.8%
IPMN	1 (4%)	14 (11%)
Other benign lesions	0	15 (12%)
Chronic pancreatitis	0	5 (4%)
Peripancreatic invasion	11 (52%)	44 (57%)	0.80
Positive surgical margins	4 (19%)	17 (22%)	0.75
Lymphovascular invasion	9 (43%)	42 (54%%)	0.46
Positive lymph node spread	11 (52%)	47 (61%)	0.62

Perioperative and survival outcomes

	≥80 years (n=24)	<80 years (n=124)	P-value
Pancreaticoduodenectomy (PD)	16 (67%)	83 (67%)	0.98
Distal Pancreatectomy (DP)	8 (33%)	41 (33%)
Operative time	228 (160 - 290)	245 (125 - 560)	0.09
Estimated blood loss (ml)	273 (20 - 1400)	312 (20 - 3000)	0.60
Perioperative blood transfusion	8 (33%)	34 (27%)	0.56
Clavien grade I and/or II complications	11 (46%)	54 (43%)	0.84
Clavien grade III and/or IV complications	5 (21%)	26 (21%)	0.99
Perioperative mortality	2 (8%)	6 (5%)	0.49
Postoperative pancreatic fistula: ISGPF (§)	6 (25%)	24 (19%)	0.53
Clinically significant pancreatic fistula ISGPF (§) grade B or C	5 (21%)	14 (18%)	0.43
Median length of hospital stay (days)	14 (4 - 41)	9 (3 - 108)	0.03
Reoperation	1 (4%)	15 (12%)	0.25
30-days postdischarge readmission	4 (17%)	25 (20%)	0.69
Delayed Gastric Emptying (DGE)	6 (25%)	17 (14%)	0.16
Survival
1 year survival	45.7%	69.1%	0.04
2 year survival	32.6%	51.8%
Median survival (months)	8.7	33.2
Cancer only 1 year survival	40.7%	56.2%	0.25
Cancer only 2 year survival	27.1%	33.5%

§ ISGPF: International study group definition of postoperative pancreatic fistula.