Major Pancreatic Resections in Patients Aged Over 75 Years Old Experience of a Single Hepatobiliary Unit

Vivian Hei Man Li*, John Isherwood, Chloe Hollobone, Cristina Pollard, Eyad Issa and Ashley
Dennison

Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, UK

^*Correspondance to: Vivian Hei Man Li 

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Abstract:

Background: Patients above the age of 65 to 70 have often been denied surgical resection or
intervention for pancreatic malignancy due to associations with significantly increased perioperative
morbidity and mortality. However, increasing evidence supports that age should not be the main
determinant of surgical resection. This study describes the surgical outcomes for patients over the
age of 75 selected for major pancreatic resection in a single tertiary hepatobiliary unit.
Methods: A single centre retrospective cohort study at a UK tertiary referral centre. Departmental
records were reviewed for patients over the age of 75 who underwent a major pancreatic resection
for malignancy.
Results: 64 patients (34 male, 30 female), aged 75 or over (median age 78) underwent a major
pancreatic resection. Forty-two patients (65.6%) had curative resections and 22 (34.4%) had
palliative procedures. The mean overall length of stay for the curative versus palliative cohorts were
12 days (range 5 to 48) and 8.5 days (range 5 to 22) respectively (p<0.018). The median HDU stay
for the curative cohort was 3 days (range 1 to 10 days) compared to 2 days (range 0 to 5 days) for
the palliative cohort (p<0.05). The overall complication rate was 34.4% and perioperatively, 45.2%
of curative patients had a postoperative complication compared to 13.6% of palliative patients. The
30 day mortality was 2.4% (n=1) for curative patients and 9.1% (n=2) for palliative patients. Patients
who underwent curative resection had a higher overall survival at 2 years (50%) compared to those
undergoing palliative intervention (22.7%). Survival curves at 2 years demonstrated significantly
greater survival for patients undergoing curative surgical intervention (p=0.0016).
Conclusion: This study suggests that major pancreatic resections in patients over the age of 75 are
safe and feasible in selected patient cohorts. The survival rates following both curative and palliative
surgical procedures in patients over the age of 75 are comparable with rates seen in younger
cohorts undergoing similar major surgical interventions. Further research is required to establish
prognostic factors associated with poor outcomes which will facilitate improving patient selection
and preoperative workup which will further improve postoperative morbidity.

Keywords:

Pancreatic resection; Outcome; Elderly; Survival

Cite the Article:

Man Li VH, Isherwood J, Hollobone C, Pollard C, Issa E, Dennison A. Major Pancreatic Resections in Patients Aged
Over 75 Years Old Experience of a Single Hepatobiliary Unit. World J Surg Surgical Res. 2019; 2: 1168..