Abstracts
1997 Digestive Disease Week

Should pancreaticoduodenectomy be performed in octogenarians?

TA Sohn, CJ Yeo, JL Cameron, KD Lillemoe, MA Talamini, RH Hruban, PK Sauter, J Coleman, SE Ord, LB Grochow, RA Abrams, HA Pitt. Departments of Surgery, Pathology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD.

As the United States population ages, an increasing number of elderly patients may be candidates for pancreaticoduodenal resection. This large volume, single-institution retrospective review examines the morbidity, mortality and long-term survival of patients 80 years and older undergoing pancreaticoduodenectomy. Methods: 727 consecutive patients undergoing pancreaticoduodenectomy between December 1986 and June 1996 were reviewed. Outcomes of patients 80 years and older were compared to those younger than 80 years. Results: Of the 727 patients undergoing pancreaticoduodenectomy, 46 patients were >=80 years old (mean age 82.9±2.7; median age, 82.0; range, 80.0 - 90.0). Pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n=25; 54%), ampullary adenocarcinoma (n=9; 20%), distal bile duct adenocarcinoma (n=5; 11%), duodenal adenocarcinoma (n=2; 4%), cystadenocarcinoma (n=2; 4%), cystadenoma (n=1; 2%) and chronic pancreatitis (n=2; 4%) in the 46 elderly patients. When compared to the 681 patients <80 years old undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to gender, race, intraoperative blood loss and type of pancreaticoduodenectomy performed. Patients >=80 years old had a shorter median operative time (6.4 hours vs. 7.0 hours; p=0.02), but a longer postoperative length of stay (median=15 days vs. 13 days; p=0.01) and a higher complication rate (58% vs 41%;p=0.03) when compared to their younger counterparts. Pancreaticoduodenectomy in this elderly group resulted in a 4.3% (n=2) perioperative mortality rate compared to 1.6% (n=10) in the younger group (p=N.S.). In patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n=495), the groups were comparable with respect to tumor diameter, resection margin status, lymph node status, tumor differentiation and site of origin of the periampullary adenocarcinoma. Patients >=80 years old (n=41) had median and 5-year survivals of 32 months and 21%, respectively, compared to 20 months and 26% in patients <80 years old (n=454; p=0.62). Conclusions: These data demonstrate that pancreaticoduodenectomy can be performed safely in the elderly, with morbidity and mortality rates comparable to those observed in younger patients. For elderly patients with periampullary malignancies, long-term survival after pancreaticoduodenal resection is possible, with results similar to that of their younger counterparts. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.