Should Pancreaticoduodenectomy Be Performed in Octogenarians?

被引：164

作者：

Sohn T.A. ^{[1
]}

Yeo C.J. ^{[1
,2
]}

Cameron J.L. ^{[1
]}

Lillemoe K.D. ^{[1
]}

Talamini M.A. ^{[1
]}

Hruban R.H. ^{[1
]}

Sauter P.K. ^{[1
]}

Coleman J. ^{[1
]}

Ord S.E. ^{[1
]}

Grochow L.B. ^{[1
]}

Abrams R.A. ^{[1
]}

Pitt H.A. ^{[1
]}

机构：

[1] Dept. of Surg., Oncol., and Pathol., Johns Hopkins Medical Institutions, Baltimore, MD

[2] Department of Surgery and Oncology, Johns Hopkins Hospital, Baltimore, MD 21287-4603, 600 N. Wolfe St.

来源：

Journal of Gastrointestinal Surgery | 1998年 / 2卷 / 3期

基金：

美国国家卫生研究院;

关键词：

Bile Duct Cancer; Johns Hopkins Hospital; Distal Bile Duct; Duodenal Adenocarcinoma; Ampullary Adenocarcinoma;

D O I：

10.1016/S1091-255X(98)80014-0

中图分类号：

学科分类号：

摘要：

As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%), distal bile duct adenocarcinoma (n = 5; 11%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 454; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.

引用

页码：207 / 216

页数：9

共 22 条

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