Short- and long-term outcomes of pancreaticoduodenectomy in elderly patients with periampullary cancer

Abstract

Purpose: Pancreaticoduodenectomy (PD) is recently performed in older cancer patients. The complication rate of PD is high. The present study was to compare the postoperative short- and long-term outcomes of PD in between older patients and younger patients.

Methods: Between 2000 and 2014, patients who underwent PD due to periampullary cancers were enrolled. Patients aged 75 years or over were included in the older group.

Results: Total 1,249 patients were enrolled in this study and 168 patients (13.5%) were included in the older group. Postoperative complication rates, duration of postoperative hospital stay, and 30-day mortality were comparable between the 2 groups, although the admission rate of intensive care unit postoperatively was higher in the older adult group (20.8% vs. 10.5%, P < 0.001). In terms of long-term outcomes, 5-year overall survival rate was lower in the older group (23.4% vs. 41.8%, P < 0.001), and 5-year cumulative recurrence rate was higher in the older group without statistical significance (63.9% vs. 57.9%, P = 0.095). However, there were no statistical differences of cumulative recurrence in pancreatic cancer patients (81.5% vs. 82.5%, P = 0.805).

Conclusion: PD for periampullary cancer is a safe and feasible treatment in the older patients. The treatment modality for obtaining better survival outcomes will be investigated.

Keywords: Geriatric assessment; Outcome assessment; Pancreaticoduodenectomy; Recurrence; Survival.

Fig. 1. (A) Proportion of the elderly patients in pancraticoduodenectomy for periampullary cancer. (B) The rates of R0 resection status and receiving chemotherapy in the elderly group.

Fig. 2. Comparisons of survival outcomes between the older and control groups who obtained R0 resection status. (A) The 5-year overall survival rate, (B) 5-year cumulative recurrence rate. 5YSR, 5-year overall survival rate; 5YCRR, 5-year cumulative recurrence rate.

Fig. 3. Comparisons of cumulative recurrence rates in R0 resection patients, pancreatic adenocarcinoma (A), distal common bile duct (CBD) cancer (B), ampullary cancer (C). 5YCRR, 5-year cumulative recurrence rate.