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Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis

Center for Surgery, Department of General and Visceral Surgery, Medical Center-University of Freiburg, 79110 Freiburg, Germany
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Received: 28 July 2020 / Revised: 19 August 2020 / Accepted: 20 August 2020 / Published: 24 August 2020
Due to increasing life expectancy and improved diagnostic sensitivity, a growing number of older patients are presenting with resectable pancreatic disease entities and are being evaluated for surgery. Intended as an internal quality control for patient selection, we aimed at evaluating septuagenarians and octogenarians compared with patients younger than 70 years of age regarding early postoperative outcome in general, and long-term oncologic outcome in the case of resection for pancreatic adenocarcinoma. A total number of 1231 patients who underwent pancreatic resection for any entity between 2007 and 2019 at our tertiary university medical center in Germany were retrospectively analyzed, accessing a prospectively maintained database. Participants were divided into three groups based on age (<70 years: N = 761; 70–79 years: N = 385; 80–89 years: N = 85) and were evaluated with regard to perioperative variables, postoperative morbidity, mortality and overall survival for the subgroup of patients with pancreatic adenocarcinoma. Pancreatic resection in older individuals was not infrequent. When surgery was performed for carcinoma, patients >70 years of age even constituted almost half of the cases. In spite of increased American Society of Anesthesiologists physical status classification (ASA)-scores and more frequent comorbidities in older patients, similar rates for postoperative morbidity and mortality were observed in all age groups. A significant disparity in the use of (neo-) adjuvant therapy between younger and older pancreatic adenocarcinoma patients was detected. However, median overall survival did not significantly differ between all age groups (<70 years: 28 (95%-CI: 22–34) months; 70–79 years: 21 (17–25) months; 80–89 years: 15 (9–21) months). In conclusion, elderly patients can experience similar perioperative outcomes to those of younger individuals after major pancreatic surgery. The survival benefit from resection of localized pancreatic adenocarcinoma is largely independent of patient age. The results are reassuring with respect to our preoperative practice and clinical judgment regarding careful patient selection. Future randomized trials should decidedly include elderly patients to generate more robust evidence to further optimize treatment recommendation and choice. View Full-Text
Keywords: pancreatic resection; elderly; surgery and geriatrics; postoperative morbidity; postoperative mortality; pancreatic adenocarcinoma overall survival pancreatic resection; elderly; surgery and geriatrics; postoperative morbidity; postoperative mortality; pancreatic adenocarcinoma overall survival
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MDPI and ACS Style

Ruess, D.A.; Biesel, E.A.; Kühlbrey, C.M.; Chikhladze, S.; Hipp, J.; Lünstedt, J.; Fichtner-Feigl, S.; Hopt, U.T.; Wittel, U.A. Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis. Surgeries 2020, 1, 30-45. https://0-doi-org.brum.beds.ac.uk/10.3390/surgeries1010005

AMA Style

Ruess DA, Biesel EA, Kühlbrey CM, Chikhladze S, Hipp J, Lünstedt J, Fichtner-Feigl S, Hopt UT, Wittel UA. Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis. Surgeries. 2020; 1(1):30-45. https://0-doi-org.brum.beds.ac.uk/10.3390/surgeries1010005

Chicago/Turabian Style

Ruess, Dietrich A., Esther A. Biesel, Christian M. Kühlbrey, Sophia Chikhladze, Julian Hipp, Jost Lünstedt, Stefan Fichtner-Feigl, Ulrich T. Hopt, and Uwe A. Wittel. 2020. "Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis" Surgeries 1, no. 1: 30-45. https://0-doi-org.brum.beds.ac.uk/10.3390/surgeries1010005

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