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. 2023 Feb 27;408(1):108.
doi: 10.1007/s00423-023-02843-2.

Risks and benefits of pancreaticoduodenectomy in patients aged 80 years and over

Naoki Ikenaga  1 , Kohei Nakata  1 , Toshiya Abe  1 , Noboru Ideno  1 , Nao Fujimori  2 , Takamasa Oono  2 , Nobuhiro Fujita  3 , Kousei Ishigami  3 , Masafumi Nakamura  4
Affiliations

Risks and benefits of pancreaticoduodenectomy in patients aged 80 years and over

Naoki Ikenaga et al. Langenbecks Arch Surg. .

Abstract

Purpose: The frequency of pancreaticoduodenectomy is increasing in oldest old patients owing to population aging. We aimed to clarify the clinical significance of pancreaticoduodenectomy in patients aged ≥ 80 years with multiple underlying diseases.

Methods: A total of 649 consecutive patients who underwent pancreaticoduodenectomy from April 2010 to March 2021 in our institute were divided into two groups according to their age: ≥ 80 years (51) and ≤ 79 years (598). We compared mortality and morbidity between the groups. The age-related prognosis was analyzed in 302 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma treatment.

Results: There were no significant differences in morbidity (Clavien-Dindo classification grade III or higher; P = 0.1300), mortality (P = 0.0786), or postoperative hospital stay (P = 0.5763) between the groups. Patients aged ≥ 80 years, who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, had shorter overall survival than those aged ≤ 79 years (median survival time, 16.7 months vs. 32.7 months; P = 0.0206). However, the overall survival of patients aged ≥ 80 years who received perioperative chemotherapy was comparable to that of patients aged ≤ 79 years (P = 0.9795). In the multivariate analysis, the absence of perioperative chemotherapy was identified as an independent prognostic factor, while age ≥ 80 years was not. Perioperative chemotherapy was the sole independent prognostic factor in patients aged ≥ 80 years who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

Conclusions: Pancreaticoduodenectomy is safe for patients aged ≥ 80 years. The survival benefits of pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma aged ≥ 80 years might be limited to those who can receive perioperative chemotherapy.

Keywords: Adenocarcinoma; Aged; Chemotherapy; Pancreaticoduodenectomy; Survival analysis.

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