Adham M, Bredt L C, Robert M, Perinel J, Lombard-Bohas C, Ponchon T, Valette P J
Department of Hepato-Biliary and Pancreatic Surgery, Lyon Faculty of Medicine-UCBL1, Edouard Herriot Hospital-HCL, Lyon, France,
Langenbecks Arch Surg. 2014 Apr;399(4):449-59. doi: 10.1007/s00423-014-1183-9. Epub 2014 Mar 27.
Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients.
The medical records of all patients who underwent pancreatic resection at our institution (2005-2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years.
A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores (P < 0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P = 0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P = 0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P = 0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P = 0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥ 70 years (HR, 3.5; 95 % CI, 1.3-9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6-96), and intraoperative blood loss were significant (P = 0.012; P = 0.015, and P = 0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively (P = 0.003).
Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family.
手术仍然是胰腺癌唯一可能的治愈性疗法，但生理储备受损和合并症可能使老年患者无法接受胰腺切除术。
回顾性分析了我院（2005 - 2012年）所有接受胰腺切除术患者的病历。比较了年龄界限为70岁的患者的术后及长期预后。
分别有228例（66%）和116例（34%）患者年龄小于70岁和大于等于70岁。老年组的美国麻醉医师协会（ASA）评分更差（P < 0.0001），侵袭性恶性病变发生率更高（75%对67%，P = 0.14），主要是胰腺导管腺癌（58.6%对44.7%，P = 0.01）。最常见的切除类型是胰十二指肠切除术（PD）（59%），其次是胰体尾切除术（19.8%）。平均住院时间相当。老年患者术后≥IIIb级并发症较少（12%对20.1%；P = 0.04），但术后死亡率较高（12.9%对3.9%；P = 0.04）。在术后死亡率的多变量Cox比例风险模型中，年龄≥70岁（风险比[HR]，3.5；95%置信区间[CI]，1.3 - 9.3）、胰十二指肠切除术（HR，12.6；95% CI，1.6 - 96）和术中失血具有显著意义（分别为P = 0.012；P = 0.015和P = 0.005）。所有患者、年龄小于70岁患者和年龄大于等于70岁患者的总体5年生存率分别为56%、55%和41%（P = 0.003）。
老年患者胰腺切除术后的死亡风险高于通常报道的病例系列。尽管如此，老年患者可以接受胰腺切除术并获得可接受的5年生存结果。我们的结果有助于为老年患者及其家属做出更好、更明智的决策。
