title: The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits.
abstract: BACKGROUND
  A pancreaticoduodenectomy (PD) offers the only chance of a cure for pancreatic cancer and can be performed with low mortality and morbidity. However, little is known about outcomes of a PD in octogenarians.
  
  
  METHODS
  Differences in two groups of patients (Group Y, <80 and Group O, ≥80 year-old) who underwent a PD for pancreatic adenocarcinoma were analysed. Study end-points were length of post-operative stay, overall morbidity, 30-day mortality and overall survival.
  
  
  RESULTS
  There were 175 patients in Group Y (mean age 64 years) and 25 patients in Group O (mean age 83 years). Octogenarians had worse Eastern Cooperative Oncology Group (ECOG) Performance Status (PS ≥1: 90% vs. 51%) and American Society of Anesthesiology (ASA) score (>2: 71% vs. 47%). The two groups were similar in underlying co-morbidities, operative time, rates of portal vein resection, intra-operative complications, blood loss, pathological stage and status of resection margins. Octogenarians had a longer post-operative stay (20 vs. 14 days) and higher overall morbidity (68% vs. 44%). There was a single death in each group. At a median follow-up of 13 months median survival appeared similar in the two groups (17 vs. 13 months).
  
  
  CONCLUSIONS
  As 30-day mortality and survival are similar to those observed in younger patients, a PD can be offered to carefully selected octogenarians.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY 10010, USA. marcovalerio.melis@nyumc.org
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
authors.forename: Francesca
authors.initials: F
authors.lastname: Marcon
authors.forename: Antonio
authors.initials: A
authors.lastname: Masi
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinna
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.forename: George
authors.initials: G
authors.lastname: Miller
authors.forename: Harvey
authors.initials: H
authors.lastname: Moore
authors.forename: Steven
authors.initials: S
authors.lastname: Cohen
authors.forename: Russell
authors.initials: R
authors.lastname: Berman
authors.forename: H Leon
authors.initials: HL
authors.lastname: Pachter
authors.forename: Elliot
authors.initials: E
authors.lastname: Newman
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009519:New York City; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome