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Inicio Cirugía Española (English Edition) Cephalic pancreatoduodenectomy in octogenarian patients with pancreatic tumors
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Vol. 101. Issue 9.
Pages 599-608 (September 2023)
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Vol. 101. Issue 9.
Pages 599-608 (September 2023)
Original article
Cephalic pancreatoduodenectomy in octogenarian patients with pancreatic tumors
Duodenopancreatectomía cefálica en pacientes octogenarios con tumores de páncreas
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4
Iago Justo Alonso, Laura Alonso Murillo, Alberto Marcacuzco Quinto, Óscar Caso Maestro, Paula Rioja Conde, Clara Fernández, Carlos Jiménez Romero
Corresponding author
carlos.jimenez@inforboe.es

Corresponding author.
Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Doce de Octubre (imas12) CIBERES, Madrid, Spain
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Tables (4)
Table 1. Preoperative variables of the patient groups.
Table 2. Intraoperative and histological variables.
Table 3. Postoperative evolution, morbidity and mortality.
Table 4. Multivariate analysis for 90-day mortality.
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Abstract
Introduction

Current literature supports the claim that performing a cephalic pancreaticoduodenectomy (CPD) as treatment for pancreatic cancer (PC) is associated with an increase in median survival, both in octogenarian (≥80 years) patients as well as younger patients.

Methods

This is a retrospective and comparative trial, comparing results for CPD performed on 30 patients ≥80 years with PC and 159 patients <80 years.

Results

The patients in the octogenarian group showed a significantly higher rate of preoperative cardiovascular morbidity and a more aggressive tumoral behaviour, including more significant preoperative anemia, jaundice and levels of CA 19-9, higher vascular and neural invasion, and a lower rate of R0 resection despite using the same surgical technique. There were no significant differences in terms of postoperative complications. Postoperative mortality was similar in both groups (3.3% in octogenarians vs 3.1% in patients <80 years). Mortality during follow-up was mainly due to tumour recurrence, cardiovascular complications and COVID-19 in 2 elderly patients.

Actuarial survival at 1, 3 and 5 years was significantly larger for patients <80 years old, as compared to octogenarians (85.9%, 61.1% and 39.2% versus 72.7%, 28.9% and 9.6%, respectively; P = 0.001). The presence of a pancreatic fistula and not using external Wirsung stenting were significantly associated with 90-day postoperative mortality after a CPD.

Conclusions

Morbidity and mortality post-CPD is similar in octogenarians and patients younger than 80, although long-term survival is shorter due to more aggressive tumours and comorbidities associated with older age.

Keywords:
Cephalic pancreatic cancer
Cephalic pancreaticoduodenectomy
Ampullary cancer
Octogenarian patients
Ageing
Resumen
Introducción

Según estudios previos, la duodenopancreatectomía cefálica (DPC) por cáncer de páncreas (CP) se asocia a un incremento de la supervivencia mediana tanto en pacientes octogenarios como en pacientes de menor edad.

Métodos

Estudio retrospectivo y comparativo de la DPC realizada en 30 pacientes ≥ 80 con CP y en 159 pacientes < 80 años.

Resultados

Los pacientes octogenarios presentaban una tasa significativamente mayor de morbilidad cardiovascular preoperatoria y un comportamiento tumoral más agresivo (mayor anemia, ictericia y CA 19-9 preoperatorios, invasión vascular y neural y menor frecuencia de resección R0 a pesar de utilizar la misma técnica quirúrgica). No hubo diferencias significativas en cuanto a complicaciones postoperatorias. La mortalidad postoperatoria fue similar en ambos grupos (3,3% en octogenarios versus 3,1% en < 80 años). Las causas de mortalidad durante el seguimiento fueron fundamentalmente por recidiva tumoral, complicaciones cardiovasculares y COVID-19 (2 octogenarios).

La supervivencia actuarial a 1, 3 y 5 años fue significativamente mayor en pacientes < 80 años que en octogenarios (el 85,9%, el 61,1 y el 39,2% versus el 72,7, el 28,9 y el 9,6%, respectivamente; p = 0,001). En el estudio multivariable, la presencia de una fístula pancreática y la no utilización de tutor externo del Wirsung influyeron de forma estadísticamente significativa sobre la mortalidad a 90 días post-DPC.

Conclusiones

La morbimortalidad post-DPC es similar en octogenarios y < 80 años, aunque la supervivencia a largo plazo es menor por la agresividad tumoral y comorbilidad asociada a la edad avanzada.

Palabras clave:
Cáncer de cabeza de páncreas
Duodenopancreatectomía cefálica
Cáncer periampular
Pacientes octogenarios
Envejecimiento

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