Duodenopancreatectomía cefálica con resección vascular laparoscópica / Laparoscopic cephalic pancreaticoduodenectomy with laparoscopic vascular resection

RESUMEN Antecedentes: la duodenopancreatectomía cefálica (DPC) con resección vascular venosa está indicada para el tratamiento del adenocarcinoma ductal y de tumores neuroendocrinos de páncreas, tanto por laparoscopia como por laparotomía. Objetivo: describir los resultados de una serie de pacientes operados de DPC con resección vascular venosa y comparar la morbimortalidad entre los abordados por laparoscopia y por laparotomía. Material y métodos: se realizó un estudio observacional, comparativo, retrospectivo de pacientes con DPC con resección vascular entre enero de 2022 y agosto de 2023. El abordaje laparoscópico fue determinado en menores de 80 años, invasión venosa tumoral igual a 180° o menor en la tomografía, buen performance status, y no haber realizado tratamiento neoadyuvante. Resultados: fueron realizadas 23 DPC con resección vascular venosa: 11 por laparoscopia y 12 por laparotomía. Las 11 realizadas por laparoscopia fueron resecciones laterales, y, en los 12 abordados por laparotomía, se realizó resección total de vena porta en 5 y en el resto, resección lateral. El tiempo de "clampeo" (pinzamiento) portal y la necesidad de transfusiones fue similar en ambos grupos. El estudio patológico reveló R0 en el 78,2% de los pacientes e invasión venosa en el 40.9%. La morbilidad con laparoscopia y con laparotomía consistió, respectivamente, en: fístula pancreática en 7 (4 y 3), vaciamiento gástrico retardado en 4 (1 y 4), fístula biliar en uno (1 y 0), neumonía en dos (1 y 1) e infección de herida en uno (0 y 1). La mortalidad fue de 8,6% por el fallecimiento de dos pacientes, uno en cada grupo. Conclusión: de acuerdo con los criterios empleados, la morbimortalidad de la DPC con resección vascular fue similar por laparoscopia y por laparotomía.

ABSTRACT Background: Cephalic pancreaticoduodenectomy (CPD) with venous resection is indicated for the treatment of ductal adenocarcinoma and neuroendocrine tumors of the pancreas, either through laparoscopy or laparotomy. Objective: The aim of this study was to describe the results of a series of patients undergoing CPD with venous vascular resection and compare morbidity and mortality between the laparoscopic approach and open surgery. Material and methods: We conducted a retrospective, comparative and observational study of patients who underwent CPD with venous vascular resection between January 2022 and July 2023. Criteria for laparoscopic surgery were age < 80 years, interface between tumor and vein of 180° of the circumference of the vessel wall or less on computed tomography, good performance status, and no previous neoadjuvant treatment. Results: A total of 23 CPD procedures with venous vascular resection were performed: 11 by laparoscopy and 12 by laparotomy. The 11 laparoscopic procedures were lateral resections, and in the 12 patients approached by laparotomy, 5 were total portal vein resections and 7 were lateral resections. Portal vein clamping time and need for transfusion was similar in both groups. The pathological examination reported R0 resections in 78.2% and venous invasion in 40.9%. The complications associated with laparoscopy and laparotomy were pancreatic fistula in 4 and 3 patients, respectively, delayed gastric emptying in 1 and 4 patients, respectively, biliary fistula in 1 and 0 patients, respectively, aspiration pneumonia i 1 and 1 patients, respectively and surgical site infection in 0 and 1 patients, respectively. Mortality was 8.6% (n =2), one in each group. Conclusion: According to the criteria used, the morbidity and mortality of CPD with vascular resection were similar for laparoscopy and laparotomy.

De trastorno neuropsiquiátrico a insulinoma, corrección diagnóstica y resolución mediante resección pancreática mayor / From a neuropsychiatric disorder to the correct diagnosis of insulinoma resolved by major pancreatic resection

RESUMEN El insulinoma es un tumor pancreático poco frecuente con una incidencia del 0,4%, generalmente benigno. Se presenta más frecuentemente en mujeres con una relación 2:1. Es el tumor neuroendocrino funcionante más común del páncreas1, responsable del 70 al 75% de hiperinsulinemía en la práctica clínica. El diagnóstico suele representar un desafío, y el retraso diagnóstico poner en riesgo la vida del paciente. El tratamiento quirúrgico es curativo en más del 90% de los casos; la táctica conservadora, siempre que sea posible, es la de elección. Informamos acerca de una duodenopancreatectomía cefálica (DPC) por insulinoma en un paciente de sexo masculino, con mala interpretación diagnóstica previa de enfermedad neuropsiquiátrica y tratado con anticonvulsivantes.

ABSTRACT Insulinomas are rare pancreatic tumors usually benign with an incidence of 0.4%. They are more common in women with a female-to-male ratio of 2:1. It is the most common functioning neuroendocrine tumor of the pancreas and is responsible for 70-75% of hyperinsulinemia in clinical practice1. The diagnosis is often a challenge, and a delay in diagnosis can have serious consequences for the patient. Surgical treatment is curative in more than 90% of cases, and the conservative approach is the treatment of choice whenever possible. We report the case of a cephalic pancreaticoduodenectomy (CPD) due to an insulinoma in a male patient with a previous misdiagnosis of a neuropsychiatric disorder treated with anticonvulsants.

Factores de mal pronóstico en 113 pacientes sometidos a duodenopancreatectomía cefálica por colangiocarcinoma distal / Prognostic risk factors in 113 patients undergoing cephalic duodenopancreatectomy for distal cholangiocarcinoma

Introducción El colangiocarcinoma distal es una neoplasia epitelial maligna que afecta a los conductos biliares extrahepáticos, per debajo del conducto cístico. Existe poca evidencia sobre la relación entre factores perioperatorios y peor evolución a largo plazo tras la resección quirúrgica. Objetivo Analizar los factores de riesgo de mortalidad y recidiva a largo plazo del colangiocarcinoma distal de los pacientes resecados. Material y métodos Se ha analizado una base de datos prospectiva unicéntrica de pacientes intervenidos por colangiocarcinoma distal entre los años 1990 y 2021 con la finalidad de investigar los factores de mortalidad y recidiva. Resultados Se han intervenido 113 pacientes, con una supervivencia actuarial media de 100,2 (76-124) meses tras la resección. El estudio bivariante no evidenció diferencias entre los pacientes dependiendo de la edad o variables preoperatorias estudiadas. La presencia de adenopatías afectadas fue un factor de riesgo de mortalidad a largo plazo en el estudio multivariante. La presencia de adenopatías afectadas, la recidiva tumoral y la fístula biliar durante el postoperatorio implicaron peor supervivencia actuarial al comparar las curvas de Kaplan-Meier. Conclusiones La presencia de adenopatías afectadas influyen en el pronóstico de la enfermedad. La aparición de fístula biliar durante el postoperatorio del colangiocarcinoma distal podría agravar los resultados a largo plazo, hallazgo que debe ser reafirmado en futuros estudios. (AU)

Introduction Distal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. Objective To analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. Materials and methods A single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. Results One hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76–124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan–Meier curves. Conclusions The presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies. (AU)

Whipple's cephalic pancreaticoduodenectomy versus pyloric-preserving pancreaticoduodenectomy. Retrospective study.

INTRODUCTION: Controversy exists in the literature as to the best technique for pancreaticoduodenectomy (PD), whether pyloric preservation (PP-CPD) or Whipple's technique (with antrectomy [W-CPD]), the former being associated with a higher frequency of delayed gastric emptying (DGE). METHODS: Retrospective and comparative study between PP-CPD technique (n = 124 patients) and W-CPD technique (n = 126 patients), in patients who were operated for tumors of the pancreatic head and periampullary region between the period 2012 and 2023. RESULTS: Surgical time was longer, although not significant, with the W-CPD technique. Pancreatic and peripancreatic tumor invasion (p = 0.031) and number of lymph nodes resected (p < 0.0001) reached statistical significance in W-CPD, although there was no significant difference between the groups in terms of lymph node tumor invasion. Regarding postoperative morbimortality (medical complications, postoperative pancreatic fistula [POPF], hemorrhage, RVG, re-interventions, in-hospital mortality, Clavien-Dindo complications), ICU and hospital stay, no statistically significant differences were observed between the groups. During follow-up, no significant differences were observed between the groups for morbidity and mortality at 90 days and survival at 1, 3 and 5 years. Binary logistic regression analysis for DGE showed that binary relevant POPF grade B/C was a significant risk factor for DGE. CONCLUSIONS: Postoperative morbidity and mortality and long-term survival were not significantly different with PP-CPD and W-CPD, but POPF grade B/C was a risk factor for DGE grade C.

Colangiocarcinoma tubulopapilar, una entidad emergente poco frecuente, a propósito de un caso

Objetivo: realizar una revisión bibliográfica y presentación de caso de colangiocarcinoma tubulopapilar. Material y Método: Se revisó la ficha médica y las características clínicas, radiológicas y patológicas del tumor, y la literatura científica respecto al carcinoma tubulopapilar. Caso Clínico: Paciente con ictericia progresiva asociado a baja de peso. El estudio imagenológico muestra amputación del tercio distal del colédoco por tejido de partes blandas, sugerente de colangiocarcinoma. Se realiza endosonografía, arrojando "fragmentos superficiales de adenocarcinoma tubulopapilar". Se realiza duodenopancreatectomía cefálica y, posteriormente, se inicia quimioterapia. Discusión: El colangiocarcinoma es una neoplasia de la vía biliar. Existen diferentes variantes histológicas, entre ellas el colangiocarcinoma tubulopapilar. Su diagnóstico se basa en estudios imagenológicos y anatomopatológicos. El principal hallazgo imagenológico va a depender del patrón de crecimiento tumoral; masiforme, periductal o intraductal. Dentro de los intraductales, se describe un carcinoma biliar con crecimiento tubulopapilar, con fenotipo pancreatobiliar epitelial. En los últimos años han sido de interés por tener mejor pronóstico. Conclusión: El colangiocarcinoma tubulopapilar es una variante histológica poco frecuente del colangiocarcinoma, que se asocia a un mejor pronóstico que otras variantes.

Objective: To conduct a literature review and present a case study of tubulopapillary cholangiocarcinoma. Material and Method: The clinical record and the clinical, radiological, and pathological characteristics of the tumor were reviewed, along with the scientific literature regarding tubulopapillary carcinoma. Case Report: Patient with progressive jaundice associated with weight loss. Imaging studies show amputation of the distal third of the common bile duct by soft tissue, suggestive of cholangiocarcinoma. Endosonography was performed, yielding "superficial fragments of tubulopapillary adenocarcinoma." Subsequently, a cephalic duodenopancreatectomy is performed, followed by chemotherapy. Discussion: Cholangiocarcinoma is a neoplasm of the biliary tract. There are different histological variants, including tubulopapillary cholangiocarcinoma. Its diagnosis is based on imaging and pathological studies. The main imaging finding will depend on the pattern of tumor growth: mass-forming, periductal, or intraductal. Among the intraductal types, a biliary carcinoma with tubulopapillary growth and an epithelial pancreatobiliary phenotype has been described. In recent years, they have been of interest due to their better prognosis. Conclusion: Tubulopapillary cholangiocarcinoma is a rare histological variant of cholangiocarcinoma that is associated with a better prognosis than other variants.

Prognostic risk factors in 113 patients undergoing cephalic duodenopancreatectomy for distal cholangiocarcinoma. / Factores de mal pronóstico en 113 pacientes sometidos a duodenopancreatectomía cefálica por colangiocarcinoma distal.

INTRODUCTION: Distal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. OBJECTIVE: To analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. MATERIALS AND METHODS: A single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. RESULTS: One hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76-124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan-Meier curves. CONCLUSIONS: The presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies.

Análisis de factores de riesgo de vaciamiento gástrico lento tras la duodenopancreatectomía cefálica / Study of risk factors for delayed gastric emptying after partial pancreatoduodenectomy

Introducción: El vaciamiento gástrico lento (VGL) es una de las complicaciones más frecuentes tras la duodenopancreatectomía cefálica. El objetivo del actual estudio es analizar los factores de riesgo de su aparición. Métodos: Análisis de factores de riesgo de VGL sobre una base de datos prospectiva de 390 pacientes intervenidos entre 2013 y 2021. Se realizó un estudio retrospectivo comparativo entre pacientes con y sin VGL y posteriormente un estudio de factores de riesgo de VGL mediante modelos de regresión logística univariante y multivariante. Resultados: La incidencia de VGL en el global de la serie fue del 28%. Un 63% de los pacientes presentaron alguna complicación y la mortalidad postoperatoria fue del 3,1%. Se evidenció que la edad mediana (73 años vs. 68 años, p<0,001) y la creatinina preoperatorias (75 vs. 68.5, p<0,001) eran superiores en el grupo VGL. El estudio de factores de riesgo evidenció que la edad superior a 60 años (p=0,002) y la fístula pancreática (p<0,001) eran factores de riesgo de VGL. Conclusiones: La presencia de fístula pancreática se confirma como factores de riesgo de VGL tras la duodenopancreatectomía. Además, se demuestra que la edad superior a 60 años es un factor de riesgo de VGL. (AU)

Introduction: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. Methods: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. Results: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63% and postoperative mortality was 3.1%. Focusing in delayed gastric emptying, it was shown that the median age (73 years vs. 68 years, p<0.001) and preoperative creatinine (75 vs. 65.5, p<0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (p=0.002) and pancreatic fistula (p<0.001) were risk factors for delayed gastric emptying. Conclusions: The presence of pancreatic fistula is confirmed as risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying. (AU)

Factores asociados a complicaciones después de duodenopancreatectomía cefálica (cirugía de Whipple) en un centro especializado / Factors associated with postoperative complications after pancreatoduodenectomy (Whipple Procedure) in a specialized center

RESUMEN Introducción: La cirugía de Whipple, también conocida como duodenopancreatectomía cefálica (DPC), es un procedimiento muy usado para varios tipos de cáncer peri ampular. Objetivos: Establecer los factores asociados a la evolución con complicaciones post DPC en el Servicio de Cirugía de Páncreas del Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú. Métodos: Se realizó un estudio observacional, cuantitativo, analítico, transversal y retrospectivo en 81 pacientes durante el período comprendido entre enero de 2017 hasta diciembre de 2019, quienes fueron sometidos a una DPC. La variable dependiente fueron las complicaciones postquirúrgicas y las independientes fueron indicadores preoperatorios, perioperatorios y post operatorios. Se revisaron las historias clínicas. Se realizó regresión logística para hallar los OR crudos y ajustados. Resultados: La media de la edad fue 65,97±10,14 y el sexo más frecuente fue el masculino. La complicación más frecuente fue la fístula pancreática (34,6%). Los factores asociados a complicaciones post DPC fueron el sexo masculino (ORa: 4,46, IC95%: 1,35-14,77), ampuloma (ORa: 6,92, IC95%: 1,75-27,48) y la consistencia blanda del páncreas (ORa: 4,52, IC95%: 0,07-0,58). Conclusiones: Los factores asociados a complicaciones en la evolución post DPC fueron el sexo masculino, el ampuloma, y la consistencia blanda del páncreas.

ABSTRACT Introduction: Whipple procedure, also known as pancreatoduodenectomy (PD), is a widely used procedure for several types of peri-ampullary cancer. Objectives: To establish the factors associated with postoperative complications after PD in the Pancreas Surgery Service of the Edgardo Rebagliati Martins National Hospital in Lima, Peru. Methods: An observational, quantitative, analytical, cross-sectional, and retrospective study was carried out on 81 patients during the period from January 2017 to December 2019, who underwent PD. The dependent variable was postoperative complications and the independent variables were preoperative, perioperative, and postoperative variables. The medical records were reviewed. Logistic regression was performed to find the crude and adjusted ORs. Results: The mean age was 65.97±10.14 and the majority of patients were male. The most common postoperative complication was pancreatic fistula (34.6%). Factors associated with postoperative complications after PD were male sex (aOR: 4.46, 95% CI: 1.35-14.77), ampullary cancer (aOR: 6.92, 95% CI: 1.75-27.48), and soft consistency of the pancreas (aOR: 4.52, 95% CI: 0.07-0.58). Conclusions: The factors associated with postoperative complications after PD were male sex, ampulloma, and soft consistency of the pancreas.

Duodenopancreatectomía cefálica en pacientes octogenarios con tumores de páncreas / Cephalic duodenopancreatectomy in octogenarium patients with pancreatic tumors

Introducción: Según estudios previos, la duodenopancreatectomía cefálica (DPC) por cáncer de páncreas (CP) se asocia a un incremento de la supervivencia mediana tanto en pacientes octogenarios como en pacientes de menor edad. Métodos: Estudio retrospectivo y comparativo de la DPC realizada en 30 pacientes≥80 años con CP y en 159 pacientes<80 años. Resultados: Los pacientes octogenarios presentaban una tasa significativamente mayor de morbilidad cardiovascular preoperatoria y un comportamiento tumoral más agresivo (mayor anemia, ictericia y CA 19-9 preoperatorios, invasión vascular y neural y menor frecuencia de resección R0 a pesar de utilizar la misma técnica quirúrgica). No hubo diferencias significativas en cuanto a complicaciones postoperatorias. La mortalidad postoperatoria fue similar en ambos grupos (3,3% en octogenarios versus 3,1% en <80 años). Las causas de mortalidad durante el seguimiento fueron fundamentalmente por recidiva tumoral, complicaciones cardiovasculares y COVID-19 (2 octogenarios). La supervivencia actuarial a 1, 3 y 5 años fue significativamente mayor en pacientes <80 años que en octogenarios (el 85,9%, el 61,1% y el 39,2% versus el 72,7%, el 28,9% y el 9,6%, respectivamente; p=0,001). En el estudio multivariable, la presencia de una fístula pancreática y la no utilización de tutor externo del Wirsung influyeron de forma estadísticamente significativa sobre la mortalidad a 90 días post-DPC. Conclusiones: La morbimortalidad post-DPC es similar en octogenarios y <80 años, aunque la supervivencia a largo plazo es menor por la agresividad tumoral y comorbilidad asociada a la edad avanzada. (AU)

Introduction: Current literature supports the claim that performing a cephalic pancreaticoduodenectomy (CPD) as treatment for pancreatic cancer (PC) is associated with an increase in median survival, both in octogenarian (≥80 years) patients as well as younger patients. Methods: This is a retrospective and comparative trial, comparing results for CPD performed on 30 patients ≥80 years with PC and 159 patients <80 years. Results: The patients in the octogenarian group showed a significantly higher rate of preoperative cardiovascular morbidity and a more aggressive tumoral behaviour, including more significant preoperative anemia, jaundice and levels of CA 19-9, higher vascular and neural invasion, and a lower rate of R0 resection despite using the same surgical technique. There were no significant differences in terms of postoperative complications. Postoperative mortality was similar in both groups (3.3% in octogenarians vs. 3.1% in patients <80 years). Mortality during follow-up was mainly due to tumour recurrence, cardiovascular complications and COVID-19 in 2elderly patients. Actuarial survival at 1, 3 and 5 years was significantly larger for patients <80 years old, as compared to octogenarians (85.9%, 61.1% and 39.2% versus 72.7%, 28.9% and 9.6%, respectively; P=0.001). The presence of a pancreatic fistula and not using external Wirsung stenting were significantly associated with 90-day postoperative mortality after a CPD. Conclusions: Morbidity and mortality post-CPD is similar in octogenarians and patients younger than 80, although long-term survival is shorter due to more aggressive tumours and comorbidities associated with older age. (AU)

Cephalic pancreatoduodenectomy in octogenarian patients with pancreatic tumors.

INTRODUCTION: Current literature supports the claim that performing a cephalic pancreaticoduodenectomy (CPD) as treatment for pancreatic cancer (PC) is associated with an increase in median survival, both in octogenarian (≥80 years) patients as well as younger patients. METHODS: This is a retrospective and comparative trial, comparing results for CPD performed on 30 patients ≥80 years with PC and 159 patients <80 years. RESULTS: The patients in the octogenarian group showed a significantly higher rate of preoperative cardiovascular morbidity and a more aggressive tumoral behaviour, including more significant preoperative anemia, jaundice and levels of CA 19-9, higher vascular and neural invasion, and a lower rate of R0 resection despite using the same surgical technique. There were no significant differences in terms of postoperative complications. Postoperative mortality was similar in both groups (3.3% in octogenarians vs 3.1% in patients <80 years). Mortality during follow-up was mainly due to tumour recurrence, cardiovascular complications and COVID-19 in 2 elderly patients. Actuarial survival at 1, 3 and 5 years was significantly larger for patients <80 years old, as compared to octogenarians (85.9%, 61.1% and 39.2% versus 72.7%, 28.9% and 9.6%, respectively; P = 0.001). The presence of a pancreatic fistula and not using external Wirsung stenting were significantly associated with 90-day postoperative mortality after a CPD. CONCLUSIONS: Morbidity and mortality post-CPD is similar in octogenarians and patients younger than 80, although long-term survival is shorter due to more aggressive tumours and comorbidities associated with older age.

Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy / La hipoalbuminemia y la edad avanzada son factores de riesgo de vaciamiento gástrico lento tras duodenopancreatectomía cefálica

Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy. (AU)

Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC. (AU)

Neoplasia pseudopapilar sólida del páncreas (tumor de Frantz) en una joven de 13 años / Solid pseudopapillary tumor of the pancreas (Frantz tumor) in a 13-year-old girl

RESUMEN El tumor sólido pseudopapilar de páncreas (TSP) es un tumor infrecuente, de bajo grado de malignidad, que representa el 1-3% de todas las neoplasias pancreáticas, con predilección por el sexo femenino, y es el tumor sólido de páncreas más frecuente en la infancia. Mujer de 13 años que consultó por dolor abdominal de 5 días de evolución, en hipocondrio derecho e irradiado a espalda, con náuseas y vómitos. TSP es diagnosticado con ecografía, tomografía computarizada (TC) y resonancia magnética (RM). Se realizó duodenopancreatectomía cefálica. La paciente fue dada de alta. El examen anatomopatológico informó un TSP de páncreas. El abordaje quirúrgico de estos tumores, abierto o laparoscópico, permite una excelente supervivencia alejada.

ABSTRACT Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm with a low malignant potential and represents 1- 3% of all pancreatic tumors. They usually occur in women and are the most common solid pancreatic tumor in children. A 13-year-old girl visited the emergency department due to abdominal pain in the right hypochondrium radiating to the back, nausea and vomiting lasting 5 days. A SPT was diagnosed by ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI). The patient underwent cephalic pancreaticoduodenectomy and was discharged. The pathological study reported a SPT of the pancreas. The surgical approach of these tumors through open surgery or laparoscopy offers excellent long-term survival.

Hypoalbuminemia and advanced age are risk factors for delayed gastric emptying after pancreaticoduodenectomy.

Introduction: Background: delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. It could be related to some baseline patient-related characteristics. This study aims to assess the predictive factors associated to DGE in the cohort of patients included in the PAUDA clinical trial. Methods: this study was a retrospective analysis based on the 80 patients included in a randomized clinical trial conducted and published by our group. A descriptive analysis and a bivariate regression model were carried out. Some factors were further scrutinized for associations using the Pearson correlation coefficient and, finally, a multiple regression model using a stepwise selection of variables was conducted. Results: DGE was diagnosed in 36 (45 %) out of 80 patients (DGE group). The number of patients older than 60 years old in the DGE group was greater than in the group without DGE (32 vs 28 patients, p = 0.009]. Likewise, the number of patients with a preoperative albumin < 35 g/L (18 vs 11 patients, p = 0.036); preoperative bilirubin > 200 µmol/L (14 vs 8 patients, p = 0.039); postoperative haemorrhage (7 vs 1 patients, p = 0.011); postoperative intraabdominal abscess (12 vs 5 patients, p = 0.017); and postoperative biliary fistula (5 vs 0 patients, p = 0.011), was also greater in the DGE group. Two risk factors were associated with DGE: the patient's age at the time of surgery and preoperative hypoalbuminemia (serum albumin concentration ≤ 35g/L). Conclusions: the patient's age at the time of surgery and the preoperative nutritional status are independent risk factors to the development of DGE after pancreatoduodenectomy.

Introducción: Introducción: el vaciamiento gástrico lento (VGL) es una complicación frecuente tras la duodenopancreatectomía cefálica (DPC) y puede relacionarse con algunas características basales del paciente. El objetivo es evaluar los factores predictivos de VGL en la cohorte de pacientes incluidos en el ensayo clínico aleatorizado PAUDA. Métodos: se realizó un análisis retrospectivo basado en los 80 pacientes incluidos en el ensayo PAUDA. Se realizaron un análisis descriptivo y un modelo de regresión bivariante. Posteriormente, algunos factores se examinaron mediante el coeficiente de correlación de Pearson y, finalmente, se llevó a cabo un modelo de regresión multivariante. Resultados: se diagnosticó VGL en 36 (45 %) pacientes. El número de pacientes mayores de 60 años en el grupo VGL fue mayor que en el grupo sin VGL (p = 0,009). El número de pacientes con albúmina preoperatoria < 35 g/L (p = 0,036); bilirrubina preoperatoria > 200 µmol/L (p = 0,039); hemorragia (p = 0,011); absceso intraabdominal (p = 0,017); y fístula biliar (p = 0,011), fue mayor en el grupo VGL. Dos factores de riesgo se asociaron con el VGL: la edad del paciente y la hipoalbuminemia preoperatoria. Conclusiones: la edad del paciente en el momento de la cirugía y el estado nutricional preoperatorio son factores de riesgo independientes de VGL tras DPC.

Morbilidad y mortalidad de la duodenopancreatectomía cefálica convencional en pacientes con enfermedad del confluente biliopancreático

Introducción: La duodenopancreatectomía cefálica es una operación cada vez más frecuente en pacientes seleccionados. Objetivo: Identificar la morbilidad y la mortalidad concerniente a la duodenopancreatectomía cefálica convencional. Métodos: Se realizó un estudio observacional, descriptivo de una serie de 15 casos operados de duodenopancreatectomía cefálica. Se investigaron las variables: estadificación según clasificación tumor, linfonódulo, metástasis (TNM), diagnóstico anatomopatológico, complicaciones, tiempo quirúrgico y estado al egreso. Se utilizaron el número absoluto y el porcentaje como medidas de resumen para las variables estadificación y diagnóstico; la media, la mediana y el rango para el tiempo quirúrgico y el intervalo de confianza para el estado al egreso. Resultados: El diagnóstico anatomopatológico principal fue adenocarcinoma de páncreas con 9 pacientes (60,1 %) y de duodeno con 2 (13,3 %). El estadio posoperatorio IIA fue el que prevaleció con 5 (45,5 %). El retraso del vaciamiento gástrico fue la complicación quirúrgica que prevaleció, con 7 (46,7 %) enfermos, seguida de la fístula biliar con 3 (20,0 %). La fístula pancreática, la lesión de la vena mesentérica superior y la hemorragia posoperatoria se presentaron una sola vez (6,7 %), respectivamente. Estas 2 últimas, provocaron la muerte del enfermo en las primeras 48 horas del posoperatorio. Fallecieron 4 (26,7 %) pacientes de la serie. Conclusiones: Las complicaciones posquirúrgicas se observan principalmente a expensas del retardo del vaciamiento gástrico, la fístula biliar y pancreática. La mortalidad puede estar relacionada con la prolongación del tiempo quirúrgico igual o mayor de 5 horas, con el consiguiente aumento de las pérdidas hemáticas.

Introduction: Cephalic duodenopancreatectomy is an increasingly frequent operation in selected patients. Objective: To identify the morbidity and mortality related to conventional cephalic duodenopancreatectomy. Methods: An observational, descriptive study of a series of 15 cases operated on cephalic duodenopancreatectomy. The variables were investigated: staging according to the Tumor, Linphonod, Metastasis (TNM) classification, pathological diagnosis, complications, surgical time and discharge status. Absolute number and percentage were used as summary measures for the variables staging and diagnosis; mean, median and range for surgical time and confidence interval for discharge status. Results: The main pathological diagnosis was adenocarcinoma of the pancreas with 9 patients (60.1%) and of the duodenum with 2 (13.3%). Postoperative stage IIA was the one that prevailed with 5 (45.5%) patients. Delayed gastric emptying was the prevailing surgical complication, with 7 (46.7%) patients, followed by biliary fistula with 3 (20.0%). Pancreatic fistula, superior mesenteric vein injury, and postoperative hemorrhage occurred only once (6.7%), respectively. These last 2, caused the death of the patient in the first 48 hours of the postoperative period. Four (26.7%) patients in the series died. Conclusions: Postoperative complications are mainly observed at the expense of delayed gastric emptying and biliary and pancreatic fistula. Mortality may be related to the prolongation of surgical time equal to or greater than 5 hours with the consequent increase of blood loss.

Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy.

INTRODUCTION: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION: The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.

Pancreatoduodenectomy due to lipomatous pseudohypertrophy of the pancreas / Pancreatoduodenectomia por pseudohipertrofia lipomatosa do pâncreas

ABSTRACT BACKGROUND: Lipomatous pseudohypertrophy of the pancreas, pancreatic lipomatosis, pancreatic steatosis, non-alcoholic fatty pancreatic disease, or fatty pancreas is an extremely rare disease, characterized by the organ enlargement and a localized or diffuse replacement of pancreatic acinar cells by mature adipose tissue, preserving the pancreatic ductal system and islets of Langerhans. AIMS: To report a rare case of lipomatous pseudohypertrophy of the pancreas in a symptomatic patient and the surgical treatment employed. METHODS: A 24-year-old male patient with weight loss (10 kilograms in 8 months), hyperglycemia, severe and recurrent acute abdominal pain, epigastric discomfort associated with nausea, vomiting, and jaundice for 40 days. Magnetic resonance imaging was performed, revealing an irregular lipomatous pseudohypertrophy of the pancreas, measuring 6.0 × 5.6 cm in the head, uncinate process, and part of the body of the pancreas. The pancreatic duct dilation was diffuse and irregular, associated with atrophy of the remnant parenchyma, particularly in the tail of the pancreas. The patient underwent pancreatoduodenectomy without total mesopancreas excision followed by pancreatojejunostomy. RESULTS: The postoperative course was uneventful, the length of stay in the ICU was two days, and the patient was discharged on the seventh postoperative day. CONCLUSIONS: The disease treatment depends on the signs and symptoms at presentation and a pancreatoduodenectomy is indicated in patients with severe and recurrent abdominal pain.

RESUMO RACIONAL: Pseudo-hipertrofia lipomatosa do pâncreas, lipomatose pancreática, esteatose pancreática, doença pancreática gordurosa não alcoólica ou pâncreas gorduroso é uma doença extremamente rara, caracterizada por aumento do órgão e substituição localizada ou difusa de células acinares pancreáticas por tecido adiposo, preservando o sistema ductal pancreático e as ilhotas de Langerhans. OBJETIVOS: Relatar um caso raro de pseudo-hipertrofia lipomatosa do pâncreas, em paciente sintomático e o tratamento cirúrgico empregado. MÉTODOS: Paciente do sexo masculino, 24 anos, com queixas de emagrecimento (10 quilos nos últimos 8 meses), hiperglicemia, dor abdominal aguda intensa e recorrente, desconforto epigástrico associado a náuseas, vômitos e icterícia há 40 dias. A ressonância magnética (RM) revelou pseudo-hipertrofia lipomatosa irregular do pâncreas, medindo 6,0 × 5,6 cm na cabeça, processo uncinado e parte do corpo do pâncreas. A dilatação do ducto pancreático era difusa e irregular, associada à atrofia do parênquima remanescente, principalmente na cauda do pâncreas. O paciente foi submetido à duodenopancreatectomia sem excisão total do mesopâncreas seguida de pancreatojejunostomia. RESULTADOS: O pós-operatório transcorreu sem intercorrências, o tempo de internação na UTI foi de 2 dias, com alta hospitalar no sétimo dia. CONCLUSÕES: O tratamento da doença depende dos sinais e sintomas na apresentação e a duodenopancreatectomia é indicada em pacientes com dor abdominal intensa e recorrente.

Duodenopancreatectomía laparoscópica: evolución de los primeros casos en Venezuela / Laparoscopic duodenopancreatectomy: evolution of the first cases in Venezuela

La duodenopancreatectomía cefálica es la única opción con criterio curativo de los tumores periampulares y cabeza de páncreas. El abordaje mínimamente invasivo ha mostrado sus beneficios en la duodenopancreatectomía cefálica lo cual ha llevado a un mayor interés a nivel mundial por esta técnica. El objetivo es describir la técnica utilizada y analizar la evolución que presentaron los primeros casos realizados en Venezuela de duodenopancreatectomía laparoscópica y así dar a conocer nuestra experiencia, es un estudio retrospectivo, descriptivo, de corte transversal; se revisaron 106 historias clínicas, obteniendo 8 casos para este estudio: 5 femeninos y 3 masculinos, los promedios de edad y tiempo de evolución de la enfermedad fueron de 54,15 años y de 7 meses respectivamente, la indicación fue 4 tumores de cabeza de páncreas y 4 periampulares, el índice de masa corporal promedio fue de 23,44 kg/mt2, el tiempo quirúrgico osciló entre 315 ­ 475 min, la estancia hospitalaria de 4 ­ 24 días, las perdidas hemáticas fueron de 200cc ± 20cc, tres pacientes presentaron complicaciones post operatorias mediatas. En conclusión, los resultados que hemos observado en nuestro reporte inicial de casos de duodenopancreatectomía laparoscópica reúnen las características de otras publicaciones similares y se ratifica los beneficios de este abordaje, la clave para la duodenopancreatectomía laparoscópica de rutina es que sea realizada en centros especializados, con protocolos estandarizados, ejecutado por cirujanos hepatobiliar y pancreática con experiencia en laparoscopia avanzada(AU)

Duodenopancreatectomy is the only option with curative criteria of the periampullary tumors and pancreatic head. The minimally invasive approach has shown its benefits in cephalic duodenopancreatectomy which has led to greater interest worldwide in this technique. The objective is to describe the technique used and analyze the evolution presented by the first cases of laparoscopic duodenopancreatectomy and thus publicize our experience, it is a retrospective, descriptive, cross-sectional study; 106 medical records were reviewed, obtaining 8 cases for this study: 5 women and 3 men, the average age and the time of evolution of the disease were 54.15 years and 7 months, the indication was 4 pancreas head and 4 periampullary tumors, the average body mass index was 23, 44 kg/mt2, assisted surgery was performed in 4 patients and 4 totally laparoscopic, the surgical time ranged between 315 - 475 min, and the hospital stay was 4 - 24 days, the blood loss was 200cc ± 20cc, three patients presented mediated postoperative complications. In conclusion, the results we have observed in our initial case report of laparoscopic duodenopancreatectomy meet the characteristics of other similar publications and the benefits of this approach are ratified, the key to routine laparoscopic duodenopancreatectomy is that it is performed in specialized centers, with standardized protocols, executed by surgeons with experience in advanced laparoscopy in addition to hepatobiliary and pancreatic surgery(AU)

Caracterización clinicoepidemiológica de pacientes operados de duodenopancreatectomía cefálica con enfermedad del confluente biliopancreático / Clinical epidemiological characterization of patients operated on cephalic pancreaticoduodenectomy with disease of the biliopancreatic confluent

Introducción: La duodenopancreatectomía cefálica continúa siendo una intervención quirúrgica compleja. Objetivo: Caracterizar a los pacientes operados de duodenopancreatectomía cefálica según variables epidemiológicas, clínicas e histológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de una serie de 15 casos operados de duodenopancreatectomía cefálica en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el quinquenio 2016-2020. Las variables analizadas fueron edad, sexo, comorbilidades, hábitos tóxicos, síntomas y signos, así como tipo histológico de las lesiones. Resultados: Predominaron los pacientes del sexo masculino (80,0 %) y el grupo de 50 a 55 años de edad (40,0 %). Las comorbilidades más frecuentes fueron la hipertensión arterial en 80,0 % de la casuística, seguida de la diabetes mellitus en 53,3 %. Prevalecieron el tabaquismo (66,7 %) y el alcoholismo (60,0 %), así como los signos de obstrucción biliar (73,3 %). El diagnóstico histológico principal fue adenocarcinoma de páncreas en 60,1 % de los afectados. Conclusiones: La duodenopancreatectomía cefálica se realiza predominantemente en pacientes con adenocarcinomas de páncreas y, en menor medida, con adenocarcinomas de duodeno y otras afecciones benignas; en afectados del sexo masculino, con edades intermedias y avanzadas de la vida, hipertensión arterial y diabetes mellitus, así como tiempo prolongado de ser fumadores y consumidores de alcohol. Los signos de obstrucción biliar son de importancia capital en el diagnóstico clínico.

Introduction: The cephalic pancreaticoduodenectomy continues being a complex surgical intervention. Objective: To characterize patients operated on cephalic duodenopancreatectomy according to selected epidemiological, clinical and histologic variables. Methods: An observational, descriptive and retrospective study of a series of 15 cases operated on cephalic pancreaticoduodenectomy was carried out in the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, during the five year period 2016-2020. The analyzed variables were age, sex, comorbidities, toxic habits, symptoms and signs, as well as histologic type of the lesions. Results: There was a prevalence of the male sex patients (80.0 %) and the 50 to 55 age group (40.0 %). The most frequent comorbidities were hypertension in 80.0 % of the case material, followed by the diabetes mellitus in 53.3 %. Nicotine addiction (66.7 %) and alcoholism (60.0 %) prevailed, as well as the signs of biliary obstruction (73.3 %). The main histologic diagnosis was pancreas adenocarcinoma in 60.1 % of those affected. Conclusions: The cephalic pancreaticoduodenectomy is carried out predominantly in patients with pancreas adenocarcinomas and, to a lesser extent, in patients with duodenum adenocarcinomas and other benign affections; in those affected of the male sex, with intermediate and advanced ages of life, hypertension and diabetes mellitus, as well as long time of being smokers and alcohol consumers. The signs of biliary obstruction are of capital importance in the clinical diagnosis.

Resección vascular mayor por adenocarcinoma pancreático ductal: reporte del primer caso registrado en Paraguay / Major vascular resection for pancreatic ductal adenocarcinoma: case report, of first case reported in Paraguay

El adenocarcinoma pancreático ductal (APD) es la cuarta causa de muerte por cáncer y se proyecta que para el 2030 ocupe el segundo lugar. El pronóstico es sombrío, siendo la sobrevida menor a 9% en 5 años. Se consideró durante mucho tiempo a la resección quirúrgica como el único tratamiento curativo, sin embargo, sólo el 15 a 20% de los pacientes pueden ser beneficiados con la misma. La clasificación pre terapéutica más utilizada es la del National Comprehensive Cáncer Network (NCCN), basada en la relación del tumor con estructuras vasculares, clasificándolos en tumores "resecables", de resección límite "Borderlines" y "localmente avanzados". Se presenta el primer caso registrado en Paraguay de APD con infiltración de la Vena Mesentérica Superior (VMS) tratado con duodenopancreatectomía cefálica (DPC) asociada a resección vascular mayor.

Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer death and is projected to rank second by 2030. The prognosis is bleak, with survival being less than 9% in 5 years. For a long time, surgical resection was considered the only curative treatment, however, only 15 to 20% of patients can benefit from it. The most widely used pre-therapeutic classification is that of the National Comprehensive Cancer Network (NCCN), based on the relationship of the tumor with vascular structures, classifying them into "resectable", "borderline" and "locally advanced" tumors. We present the first registered case in Paraguay of PDA with infiltration of the Superior Mesenteric Vein (SMV) treated with cephalic duodenopancreatectomy (CPD) associated with major vascular resection.

Duodenopancreatectomía por adenocarcinoma ductal de páncreas en ancianos. ¿Podemos asumirla con seguridad? / Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?

Introducción: La cirugía y la quimioterapia han aumentado la supervivencia de los pacientes con neoplasias pancreáticas. La disminución de la morbimortalidad postoperatoria y el aumento de la esperanza de vida han ampliado las indicaciones de la duodenopancreatectomía cefálica (DPC), aunque sigue siendo controvertida en la población geriátrica. Métodos: Estudio observacional retrospectivo sobre una base de datos prospectiva, de pacientes con adenocarcinoma ductal de páncreas sometidos a una DPC entre 2007-2018. El objetivo principal fue analizar la morbimortalidad y supervivencia asociada a la DPC en pacientes≥75 años (ancianos). Resultados: Se incluyeron 79 pacientes, 21 de ellos mayores de 75 años (27%); dentro de este grupo el 23,9% tenían más de 80 años. El ASA de ambos grupos fue similar. Los pacientes≥75años requirieron más transfusiones. No se observaron diferencias en el tiempo operatorio, aunque en los ancianos se realizaron más resecciones vasculares (26 vs. 8,7%; p=0,037).La morbilidad fue mayor en los ancianos (61,9 vs. 46,6%), aunque sin diferencias. Los≥75años presentaron más complicaciones no quirúrgicas (33,3%; p=0,050) siendo la neumonía la más frecuente. La mortalidad postoperatoria fue superior en los≥75años (9 vs. 0%; p=0,017), constituyendo la resección venosa un factor de riesgo (p=0,01). La supervivencia global y la supervivencia libre de enfermedad no mostraron diferencias significativas en ambos grupos. Conclusiones: Los pacientes ancianos presentaron una mayor mortalidad postoperatoria y más complicaciones no quirúrgicas. La supervivencia no mostró diferencias, por lo que, con una adecuada selección de pacientes, la edad no debe constituirse por sí misma como una contraindicación para la DPC(AU).

Introduction: Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. Methods: Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). Results: 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. Conclusions: Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC(AU).