Surgical aspects in management of hepato-pancreatico-biliary tumours in the elderly.
Hepato-pancreatico-biliary (HPB) surgery encompasses major hepatic resection and pancreatic surgery, both procedures of high complexity with a potentially high complication rate. The establishment of centres of excellence with a high patient volume has lowered the complication and increased the resection rate. Besides this, increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Because elderly patients have more co-morbidities and decreased life expectancy, the benefit of these procedures must be critically evaluated in such patients. Analysis of the literature on this subject demonstrated that pancreatico-duodenectomy can be performed safely in selected elderly patients (80 years of age or older), with morbidity and mortality rates approaching those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumour or gallbladder carcinoma. Nevertheless, those elderly patients who will benefit from surgery must be critically selected.
di Sebastiano
Pierluigi
P
Department of Surgery, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo, Italy. p.disebastiano@operapadrepio.it
Festa
Leonardina
L
Büchler
Markus W
MW
di Mola
Fabio F
FF
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001661:Biliary Tract Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006299:Health Services for the Aged; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D008297:Male; D010190:Pancreatic Neoplasms / Q000191:economics / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome