title: Pancreaticoduodenectomy in elderly adults: is it justified in terms of mortality, long-term morbidity, and quality of life?
abstract: OBJECTIVE
  To evaluate long-term morbidity, mortality, and quality of life (QoL) after pancreaticoduodenectomy (PD) in elderly adults.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
  
  
  METHODS
  One hundred and sixty-eight individuals aged 70 and older who underwent PD between 1995 and 2010.
  
  
  METHODS
  A prospective pancreatic surgery database was analyzed for postoperative morbidity; mortality; intensive care unit (ICU), hospital, and rehabilitation facility stay; and readmissions after surgery. QoL was assessed using a validated questionnaire completed 3, 6, and 12 months after surgery.
  
  
  RESULTS
  Seventy-two percent of the participants had an American Society of Anesthesiologists score of 3 or greater. There was no intraoperative death. Thirty- and 60-day postoperative mortality rates were 5.9% and 6.5%, respectively. Median ICU stay was 2 days, and median hospital stay was 22 days. Sixty-four participants (37.5%) were discharged to a rehabilitation facility. The first-year readmission rate was 31%. One- and 2-year overall survival rates were 58% and 36%, respectively. Global QoL scores 3 and 12 months after surgery were 68% and 73%, respectively. Scores were lower yet comparable with those of matched individuals undergoing laparoscopic cholecystectomy.
  
  
  CONCLUSIONS
  Most elderly adults with pancreatic cancer survive longer than 1 year after PD; 36% survive longer than 2 years. These individuals are likely to have acceptable long-term morbidity and overall good QoL, corresponding with their age.
authors.affiliation: Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. fabian.ger@gmail.com
authors.forename: Fabian
authors.initials: F
authors.lastname: Gerstenhaber
authors.forename: Julie
authors.initials: J
authors.lastname: Grossman
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.forename: Eran
authors.initials: E
authors.lastname: Itzkowitz
authors.forename: Ido
authors.initials: I
authors.lastname: Nachmany
authors.forename: Ronen
authors.initials: R
authors.lastname: Sever
authors.forename: Menahem
authors.initials: M
authors.lastname: Ben-Haim
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000401:mortality; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011788:Quality of Life; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: elderly; long-term morbidity; mortality; pancreaticoduodenectomy; quality of life