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Background: Given that the life expectancy is increasingly becoming longer, safety and efficacy of pancreaticoduodenectomy for periampullary cancers in elderly patients is a great clinical concern. Over the last decade many reports have described outcome of pancreaticoduodenectomy in elderly patients, but the results are still inconsistent.
Methods: From a database of all the patients with periampullary cancers undergoing pancreaticoduodenectomy between 2001 and 2009, the patients over 80 years were identified. Perioperative characteristics, postoperative complications, mortality, and a long-term survival were retrospectively compared between the patients aged 80 and older, and the patients younger than 80 years.
Results: Among a total of 561 patients undergoing pancreaticoduodenectomy, 22 patients (3.9%) were over 80 years. The pathological diagnosis in the elderly patients consisted of as follows; pancreatic cancer (n=8), bile duct cancer (n=5), ampullary neoplasm (n=5), intraductal papillary mucinous neoplasm (n=3), and gallbladder cancer (n=1). The elderly patients had a higher ASA score (P=0.02) than the younger patients, but there was no significant difference in operative time (455 vs 520 minutes; P=0.08), and blood loss (654 vs 838 ml; P=0.38). The mortality rate was 4.5% in the elderly patients and 0.9% in the younger patients, though the difference was not statistically significant (p=0.106). Although the incidence of postoperative pancreatic fistula and delayed gastric emptying were similar between the two groups, that of intraabdominal abscess, intraabdominal hemorrhage, pneumonia and ascites in the elderly patients (22.7%, 18.2%, 9.1% and 4.5%, respectively) were higher than in the younger patients (6.9%, 2.2%, 0.6% and 0.2%, respectively). The rate of grade IIIa or higher complication (Clavien-Dindo classification) was 27.3% in the elderly patients and 6.3% in the younger patients (P=0.008). There was no significant difference in overall survival between the two groups. Among the elderly patients, the median survival for those with pancreatic cancer was significantly shorter than that with non-pancreatic cancer. (P=0.003)
Conclusions: Pancreaticoduodenectomy in patients aged 80 and older should be indicated carefully, because of the higher incidence of the severe postoperative complications. Pancreaticoduodenectomy for pancreatic cancer in elderly patients could not provide a satisfactory outcome in terms of a long-term survival compared with that for non-pancreatic cancers.