PANCREATICODUODENECTOMY FOR PANCREATIC DUCTAL ADENOCARCINOMA IN THE OCTOGENARIAN
Tariq Almerey*, David Hyman, Isaac Hammons, Amer Mujkanovic, trevor betros, John Stauffer
surgery, Mayo Foundation for Medical Education and Research, Rochester, MN
Objective:
The incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing with an estimated 60,400 adults diagnosed and 48,220 deaths during 2021 alone in the United States. The Majority of newly diagnosed patients are in their 7th and 8th decade of life. Unfortunately elderly patients diagnosed with treatable PDAC, are not getting standard surgical resection due to age. Our aim is to evaluate the safety and short-term outcomes of pancreaticoduodenectomy (PD) for PDAC in the Octogenarian.
Methods:
This was a retrospective review of patients (age > 80) who underwent PD for PDAC at single institution from May 2010 to July 2020. Patient demographics and 90-day surgical outcomes were collected. Major morbidity was defined as Clavien Dindo (CD) IIIb-IVb. Postoperative pancreatic fistula (POPF) was graded according to the International Study Group (ISGPS) and clinically relevant postoperative pancreatic fistula (CR-POPF) was defined as Grade B and C.
Results:
Of 370 patients who underwent surgical resection for PDAC, we identified 35 patients who met criteria. 16 cases were female; 19 cases were male. Mean age was 84 years old. Average BMI 25. Most patients had ASA class III and above (91%).
60% of patients had no complications. The 90-days mortality and major morbidity were 2.7% and 7% respectively. Mean blood loss, operative time and length of stay was 317 cc, 306 min and 8 days respectively.
CR-POPF rate was 5.4%. Post-pancreatectomy hemorrhage rate was 8.1%.
Conclusions:
Pancreaticoduodenectomy is safe and feasible in elderly patients with minimal mortality and morbidity in experienced high-volume centers. Standard surgical resection for PDAC in suitable patients should be offered regardless of age.
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