title: Pancreatic stump closure after pancreatoduodenectomy in elderly patients: a retrospective clinical study.
abstract: BACKGROUND
  Pancreatic fistula (PF) after pancreatoduodenectomy (PD) represents the major source of morbidity. Derivative procedures are preferred by pancreatic surgeons, but the optimal management of remnant pancreatic stump remains controversial.
  
  
  OBJECTIVE
  The purpose of this retrospective study is to evaluate the efficacy and safety of pancreatic stump closure in selected elderly patients (>65 years).
  
  
  METHODS
  Clinical data of 44 PD undergone mechanical closure of the pancreatic stump performed between 2001 and 2014 in two department of general and oncologic surgery were retrospectively collected. Considering the age, patients were divided into two groups: 21 patients of less than 65 years (Group A) and 23 patients of more than 65 years (Group B).
  
  
  RESULTS
  A soft pancreatic parenchyma with a not-dilated duct (diameter <3 mm) was reported in all the 44 patients. A grade-A PF, which did not required further treatments, developed in 20 cases (45.4%; 13 in group A and 7 in group B; p < 0.05), grade-B in 5 patients (11.4%; 3 in group A and 2 in group B; statistically not significant) and a grade-C PF was observed only in one patient (2.2%; 1 in group A and 0 in group B).
  
  
  CONCLUSIONS
  In selected "high risk" elderly patients (>65 years) with soft pancreatic texture, the closure of the pancreatic stump can be a useful tool in the surgical armamentarium with the aim to reduce the incidence of age-related complications.
  
  
  CONCLUSIONS
  Prospective randomized controlled trial to better evaluate PF risk factors is needed.
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Medical School, General Surgery and Surgical Specialties Unit, S. Maria University Hospital, University of Perugia, Terni, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Division of Medical Oncology, Department of Internal and Experimental Medicine "F. Magrassi", School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
authors.affiliation: Division of Medical Oncology, Department of Internal and Experimental Medicine "F. Magrassi", School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
authors.affiliation: Medical School, General Surgery and Surgical Specialties Unit, S. Maria University Hospital, University of Perugia, Terni, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: Division of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy. giovanni.conzo@unina2.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Elderly patients; Pancreatic cancer; Pancreatic duct occlusion; Pancreatic fistula; Pancreatoduodenectomy