Pancreatic Surgery in the Very Old: Face to Face With a Challenge of the Near Future

• Published in: World journal of surgery 2013-05, Vol.37 (5), p.1013-1020
• Main Authors: Belyaev, Orlin, Herzog, Torsten, Kaya, Guelnur, Chromik, Ansgar M., Meurer, Kirsten, Uhl, Waldemar, Müller, Christophe A.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Age Factors; Aged, 80 and over; Cardiac Surgery; Chronic Obstructive Pulmonary Disease; Chronic Pancreatitis; Female; Follow-Up Studies; Gastric Emptying; General Surgery; Germany; Hospitals, High-Volume; Humans; Kaplan-Meier Estimate; Length of Stay - statistics & numerical data; Male; Medicine; Medicine & Public Health; Pancreatectomy - mortality; Pancreatic Cancer; Pancreatic Diseases - mortality; Pancreatic Diseases - surgery; Pancreatic Fistula; Pancreaticoduodenectomy - mortality; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Surgery; Survival Rate; Thoracic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-013-1944-6

Background The proportion of octogenarians requiring surgery for pancreatic disease is rapidly growing. This trend will be continued during the next decades, posing a challenge to surgeons and the health care system worldwide. This study aimed to analyze the results of pancreatic surgery in octogenarians in terms of safety and survival based on a cohort of patients at a European high-volume center. Methods During a 7-year period, 1,705 operations were performed, 76 in patients ≥80 years of age. Data on the octogenarians were retrospectively reviewed and compared to those of the whole collective and to contemporary data from the literature. Primary endpoints were mortality, morbidity, and survival. Results Overall, 80 % had a malignant disease, and resections were performed in 50 % of all cases. Mortality was 11.8 % and morbidity 72.4 %. There were significantly more medical than surgical complications: 56.6 versus 34.2 %. Pancreatic fistula occurred in 5.3 %, postoperative bleeding in 3.9 %, and delayed gastric emptying in 19.7 %. The median hospital stay was 15 days and the intensive care unit stay 2 days. Mean survival was 28.2 months and in patients with cancer 22.6 months. The 1-, 3-, and 5-year survival rates were 61.4, 31.3, and 18.8 %, respectively. Conclusions Despite high mortality and morbidity rates, surgery remains the only chance for cure in most octogenarians with pancreatic disease. Careful patient selection is the key to success and improved long-term survival in this group, which will represent a substantial fraction of the population in the near future.