Resumen de Pancreaticoduodenectomy in Elderly Adults:: Is It Justified in Terms of Mortality, Long-Term Morbidity, and Quality of Life?
Julie Grossman, Nir Lubezky, Eran Itzkowitz, Ido Nachmany, Fabian Gerstenhaber, Ronen Sever, Menahem Ben-Haim, Richard Nakache, Joseph M. Klausner, Guy Lahat
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.
