title: Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study.
abstract: BACKGROUND
  The increasing elderly population is an inevitable trend worldwide in developed countries. Therefore, we aimed to assess the experience of a tertiary pancreatic center with a very homogenous population comprising only patients diagnosed with PDAC of the pancreatic head in patients older than 75 years of age compared to their younger counterparts regarding the benefit in life expectancy and tumor biological aggressiveness.
  
  
  METHODS
  300 patients underwent partial pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for PDAC of the pancreatic head between 2002 and 2012 and were evaluated with regard to their co-morbidities, clinicopathological and perioperative variables, postoperative morbidity, mortality and long term survival. Therefore, two groups according to the age at the procedure (A: <75 years, n = 241, B: ≥75 years, n = 59) were designed.
  
  
  RESULTS
  There were no differences between groups with regard to gender, performed procedure (PPPD or PD), operation time, blood loss, tumor invasiveness and grade of tumor differentiation, R-status, lymph node ratio, 30-day mortality, length of stay and adjuvant chemotherapy. Extended resections including total pancreatectomy were slightly more often performed in younger patients (p = 0.071) and trended toward a higher rate of surgical complications in patients <75 years of age (p = 0.183). A higher rate of preoperative co-morbidities in elderly patients (group B), was associated with more postoperative non-surgical complications (p = 0.002) in this group of patients. However, the median overall survival (19.2 vs. 18.4 months) did not differ significantly between groups.
  
  
  CONCLUSIONS
  Major pancreatic surgery for ductal adenocarcinoma of the pancreatic head is justified in elderly patients. With careful patients' selection and prudent perioperative management, elderly patients will have a similar long term outcome despite the higher rate of postoperative morbidity based on non-surgical complications.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Bernhard W
authors.initials: BW
authors.lastname: Renz
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Philippe N
authors.initials: PN
authors.lastname: Khalil
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Mikhailov
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Graf
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Tobias S
authors.initials: TS
authors.lastname: Schiergens
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Niess
authors.affiliation: Department of Haematology and Oncology, University of Munich, Campus Grosshadern, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Boeck
authors.affiliation: Department of Haematology and Oncology, University of Munich, Campus Grosshadern, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, and Vascular Surgery, University of Magdeburg, Magdeburg, Germany.
authors.forename: Christiane J
authors.initials: CJ
authors.lastname: Bruns
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany; Pancreatic Cancer Center Munich, Comprehensive Cancer Center-LMU, University of Munich, Munich, Germany. Electronic address: axel.kleespies@med.uni-muenchen.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Complications; Elderly patients; Pancreatic cancer; Pancreaticoduodenectomy; Surgery