title: Is pancreaticoduodenectomy justified in elderly patients?
abstract: BACKGROUND
  Although mortality & morbidity for pancreaticoduodenectomy (PD) have improved significantly over the last two decades, the concern for elderly undergoing PD remains. This study examines the outcome of the elderly patients who had pancreaticoduodenectomy in our institution.
  
  
  METHODS
  A prospective database comprising 69 patients who underwent pancreaticoduodenectomy between 2001 and May 2008 was analyzed. Using WHO definition, elderly patient is defined as age 65 and above in this study. Two groups of patients were compared [Group 1: Age ≤65 & Group 2: Age >65].
  
  
  RESULTS
  The mean age of our patients was 62 ± 11 years. There were 37 (54%) patients in Group 1 and 32 (46%) patients in Group 2. There was no statistical difference between the two groups in terms of gender and race. However, there were more patients in the Group 2 with >2 comorbidities (p = 0.03). The median duration of operation was significantly longer in Group 2 (550 min vs 471 min, p = 0.04). Morbidity rate in Group 2 was higher (56% vs. 44%, p = 0.04). There was higher proportion of post-operative pancreatic fistula (POPF) in the elderly group (37.5% vs. 16.7%, p = 0.05). Majority of them are Grade A POPF according to the ISG definition. The median post-operative length-of-stay (LOS) in hospital was 9 days longer in Group 2 (p = 0.01). Mortality rate between the 2 groups of patients was comparable (0% vs. 3%, p = 0.28).
  
  
  CONCLUSIONS
  Elderly patients are at increased risk of morbidity in pancreatocoduodenectomy, in particular POPF. However, morbidity and mortality rates are acceptable. It is therefore justified to offer PD to elderly patients who do not have significant cardiopulmonary comorbidities.
authors.affiliation: Department of Surgery, Digestive Disease Centre, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 304833, Singapore.
authors.forename: A W C
authors.initials: AW
authors.lastname: Kow
authors.forename: N A
authors.initials: NA
authors.lastname: Sadayan
authors.forename: A
authors.initials: A
authors.lastname: Ernest
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.forename: C Y
authors.initials: CY
authors.lastname: Chan
authors.forename: C K
authors.initials: CK
authors.lastname: Ho
authors.forename: K H
authors.initials: KH
authors.lastname: Liau
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality*; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012846:Singapore; D016019:Survival Analysis; D016896:Treatment Outcome