ABSTRACT
BACKGROUND/AIMS: To assess the indications for and results of pancreaticoduodenectomy in patients more than 70 years old with periampullary cancer. METHODOLOGY: Thirty-four consecutive patients older than 70 years with periampullary cancer. The surgical procedure was pancreaticoduodectomy (Whipple's operation) with an extensive dissection of lymph nodes and the connective tissue in the peripancreatic region. Main outcome measures were postoperative morbidity and mortality, median and 5-year survival rates. RESULTS: Postoperative medical complications occurred in 24% and surgical complications in 53% of the patients. Four patients (12%) died in the postoperative period (within 30 days), and 3 patients (9%) died later in the postoperative course. The cumulative and age corrected 5-year survival rate for the remaining patients was 26%. Fifteen patients died of recurrence, and 7 patients of other causes. Five patients are still alive more than 5 years after surgery. In patients with noncurative operation the median survival time was 1 1/2 years, which is longer than would be expected from other palliative procedures. Apart from a moderately increased postoperative mortality the results were similar to those reported for younger patients. CONCLUSIONS: Pancreaticoduodenectomy should be considered in patients older than 70 years with resectable periampullary cancer. A 5-year survival rate of 20-35% can be obtained. Palliative resection may be indicated in patients in good general condition, as resection gives the best palliation and longer survival than other palliative methods.
Subject(s)
Adenocarcinoma/surgery , Duodenal Neoplasms/surgery , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Adenocarcinoma/diagnosis , Aged , Duodenal Neoplasms/diagnosis , Female , Humans , Male , Palliative Care , Pancreatic Neoplasms/diagnosis , Pancreaticoduodenectomy/adverse effectsABSTRACT
Thirty-four consecutive patients with an age over 70 years with periampullary cancer were operated on with pancreaticoduodenectomy (Whipple's procedure). The operative procedure included an extensive dissection of the regional connective tissue and lymph nodes including the retroperitoneum. Postoperative medical complications occurred in 24% and surgical complications in 53% of the patients. Four patients (12%) died in the postoperative period (within 30 days), and three patients (9%) died later in the postoperative course. The cumulative and age corrected five-year survival for the remaining patients was 26%. Fifteen patients died from recurrence, and seven patients from other causes. In patients with a non-radical operation the median survival was 1 1/2 years, which is longer than could be expected with other palliative procedures. Apart from a moderately increased postoperative mortality the results were similar to those reported for younger patients. In conclusion, pancreaticoduodenectomy may be considered in patients with an age over 70 years with operable periampullary cancer. A five-year survival rate of 20-35% can be obtained. Palliative resection is indicated in patients in good general condition, as resection gives the best palliation and longer survival than other palliative methods.