Survival after pancreaticoduodenectomy for ampullary cancer is not affected by age.
BACKGROUND
Although pancreaticoduodenectomy (PD) provides the best chance of survival for elderly patients with ampullary carcinoma, it is associated with considerable surgical risk. The aim of the present study was to compare the benefits and risks of pancreaticoduodenectomy as a treatment of ampullary carcinoma between young and elderly patients.


METHODS
We retrospectively reviewed the medical records of 171 consecutive patients treated at our hospital. Comparison of the biological aggressiveness of ampullary cancer between old and younger patients was also performed by immunohistochemical study of several prognostic biological markers, including MUC1, MUC2, CK17, and CDX2.


RESULTS
For patients in whom ampullary carcinoma was presumed resectable preoperatively, actuarial survival was significantly poorer in 55 elderly patients because 9 of them did not have PD (the other 46 had PD) than in 101 younger patients (all had PD). Multivariate analysis indicated that PD was the only independent prognostic factor; age was not. There were no significant differences in MUC1, CK17, MUC2, and CDX2 immunohistochemical staining of ampullary carcinomas between elderly and young patients. In spite of increased co-morbidities, PD could be performed as safely in elderly patients as in young patients. After PD, the actuarial survival was similar between old and young patients.


CONCLUSIONS
Our data support the conclusion that ampullary cancers in elderly patients should be treated as aggressively as in younger patients.
Yeh
Chi-Chuan
CC
Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, National Taiwan University College of Medicine, Taipei, 10002, Taiwan, ROC.
Jeng
Yung-Ming
YM
Ho
Cheng-Maw
CM
Hu
Rey-Heng
RH
Chang
Hsiu-Pi
HP
Tien
Yu-Wen
YW
D000230:Adenocarcinoma / Q000378:metabolism / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis