Subtotal pancreatectomy for cancer can be safe in the elderly

Abstract

Objectives: Evaluation of safety of subtotal pancreatectomy for cancer in elderly patients (70 years of age or more) and of long term survival compared with younger patients.

Design: Retrospective study of information recorded prospectively in the departmental database.

Setting: University hospital, Sweden.

Subjects: 74 consecutive patients who underwent subtotal pancreatectomy for cancer between 1985 and 1993.

Main outcome measures: Postoperative mortality and morbidity, and long term survival.

Results: The diagnosis was pancreatic cancer in 41, cancer of the papilla of Vater in 17, cancer of the bile duct in 7, juxtapapillary duodenal cancer in 5, and 4 other pancreatic head tumours. There were no differences in sex, first symptom, preoperative weight loss, radicality according to the pathology report, tumour size, grade of differentiation or presence of lymph node metastases between the two groups. The rate of postoperative complications was the same for both groups, as was the amount of intraoperative bleeding, operation time, and length of hospital stay including stay at the intensive care unit (ICU). Hospital mortality was 4% for the younger and 7% for the elderly (p = 0.61). The long term survival was the same in the two age groups both when all patients were included and when patients with pancreatic cancer were analysed separately.

Conclusion: Subtotal pancreatectomy for cancer can be done safely in the elderly which is why chronological age alone is not a contradiction to resection of a periampullary or pancreatic head malignancy provided that the patients are carefully selected.