title: Factors influencing survival after pancreatoduodenectomy for ductal adenocarcinoma depend on patients' age.
abstract: BACKGROUND
  It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups.
  
  
  METHODS
  Data of 251 patients after pancreatoduodenectomy for PDAC between 1999 and 2012 were analyzed. The Kaplan-Meier method and log-rank test were used to calculate survival and to compare differences between groups. The Cox proportional hazard model was applied to indentify independent prognosticators.
  
  
  RESULTS
  The overall median survival was 14.9 months. Postoperative morbidity was 25.5% with a 5.1% mortality rate. No significant differences in the overall morbidity (22.4 vs. 29.6%) or mortality (2.8 vs. 8.3%) rates were observed between different patients' age groups (<70 years and >70 years). Multivariate analysis revealed R1 resection (HR 1.76) and poor tumor differentiation (G3-G4) (HR 1.48) were independent negative factors for survival in patients <70 years. Lymph-node metastases (N1) - HR 4.89 and perineural invasion - HR 2.73 were independent prognosticators in the elderly.
  
  
  CONCLUSIONS
  Our study highlighted different factors influencing long-term survival after pancreatoduodenectomy: R1 resection and poor tumor differentiation (G3-G4) were independent negative factors for survival in patients <70 years, while perineural invasion and lymph-node metastases result in worse survival among the elderly.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Urbonas
authors.forename: Antanas
authors.initials: A
authors.lastname: Gulbinas
authors.forename: Giedrė
authors.initials: G
authors.lastname: Smailyte
authors.forename: Darius
authors.initials: D
authors.lastname: Pranys
authors.forename: Aldona
authors.initials: A
authors.lastname: Jakstaite
authors.forename: Juozas
authors.initials: J
authors.lastname: Pundzius
authors.forename: Giedrius
authors.initials: G
authors.lastname: Barauskas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis