title: Pancreatic resection in elderly patients: should it be denied?
abstract: BACKGROUND
  Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients.
  
  
  METHODS
  The medical records of all patients who underwent pancreatic resection at our institution (2005-2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years.
  
  
  RESULTS
  A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores (P < 0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P = 0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P = 0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P = 0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P = 0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥ 70 years (HR, 3.5; 95 % CI, 1.3-9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6-96), and intraoperative blood loss were significant (P = 0.012; P = 0.015, and P = 0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively (P = 0.003).
  
  
  CONCLUSIONS
  Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family.
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, Lyon Faculty of Medicine-UCBL1, Edouard Herriot Hospital-HCL, Lyon, France, mustapha.adham@chu-lyon.fr.
authors.forename: M
authors.initials: M
authors.lastname: Adham
authors.forename: L C
authors.initials: LC
authors.lastname: Bredt
authors.forename: M
authors.initials: M
authors.lastname: Robert
authors.forename: J
authors.initials: J
authors.lastname: Perinel
authors.forename: C
authors.initials: C
authors.lastname: Lombard-Bohas
authors.forename: T
authors.initials: T
authors.lastname: Ponchon
authors.forename: P J
authors.initials: PJ
authors.lastname: Valette
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome