Surgical palliation of unresectable pancreatic head cancer in elderly patients.
OBJECTIVE
To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer.


METHODS
Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life.


RESULTS
Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively).


CONCLUSIONS
Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.
Hwang
Sang Il
SI
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-Ku, Seoul, South Korea.
Kim
Hyung Ook
HO
Son
Byung Ho
BH
Yoo
Chang Hak
CH
Kim
Hungdai
H
Shin
Jun Ho
JH
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000368:Aged; D015904:Biliopancreatic Diversion; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
D001663:Bilirubin