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J Am Geriatr Soc. 2013 Aug;61(8):1351-7. doi: 10.1111/jgs.12360. Epub 2013 Jul 18.

Pancreaticoduodenectomy in elderly adults: is it justified in terms of mortality, long-term morbidity, and quality of life?

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1
Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. fabian.ger@gmail.com

Abstract

OBJECTIVES:

To evaluate long-term morbidity, mortality, and quality of life (QoL) after pancreaticoduodenectomy (PD) in elderly adults.

DESIGN:

Retrospective cohort study.

SETTING:

Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.

PARTICIPANTS:

One hundred and sixty-eight individuals aged 70 and older who underwent PD between 1995 and 2010.

MEASUREMENTS:

A prospective pancreatic surgery database was analyzed for postoperative morbidity; mortality; intensive care unit (ICU), hospital, and rehabilitation facility stay; and readmissions after surgery. QoL was assessed using a validated questionnaire completed 3, 6, and 12 months after surgery.

RESULTS:

Seventy-two percent of the participants had an American Society of Anesthesiologists score of 3 or greater. There was no intraoperative death. Thirty- and 60-day postoperative mortality rates were 5.9% and 6.5%, respectively. Median ICU stay was 2 days, and median hospital stay was 22 days. Sixty-four participants (37.5%) were discharged to a rehabilitation facility. The first-year readmission rate was 31%. One- and 2-year overall survival rates were 58% and 36%, respectively. Global QoL scores 3 and 12 months after surgery were 68% and 73%, respectively. Scores were lower yet comparable with those of matched individuals undergoing laparoscopic cholecystectomy.

CONCLUSION:

Most elderly adults with pancreatic cancer survive longer than 1 year after PD; 36% survive longer than 2 years. These individuals are likely to have acceptable long-term morbidity and overall good QoL, corresponding with their age.

KEYWORDS:

elderly; long-term morbidity; mortality; pancreaticoduodenectomy; quality of life

PMID:
23865843
DOI:
10.1111/jgs.12360
[Indexed for MEDLINE]
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