Ikenaga Naoki, Nakata Kohei, Abe Toshiya, Ideno Noboru, Fujimori Nao, Oono Takamasa, Fujita Nobuhiro, Ishigami Kousei, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Langenbecks Arch Surg. 2023 Feb 27;408(1):108. doi: 10.1007/s00423-023-02843-2.
The frequency of pancreaticoduodenectomy is increasing in oldest old patients owing to population aging. We aimed to clarify the clinical significance of pancreaticoduodenectomy in patients aged ≥ 80 years with multiple underlying diseases.
A total of 649 consecutive patients who underwent pancreaticoduodenectomy from April 2010 to March 2021 in our institute were divided into two groups according to their age: ≥ 80 years (51) and ≤ 79 years (598). We compared mortality and morbidity between the groups. The age-related prognosis was analyzed in 302 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma treatment.
There were no significant differences in morbidity (Clavien-Dindo classification grade III or higher; P = 0.1300), mortality (P = 0.0786), or postoperative hospital stay (P = 0.5763) between the groups. Patients aged ≥ 80 years, who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, had shorter overall survival than those aged ≤ 79 years (median survival time, 16.7 months vs. 32.7 months; P = 0.0206). However, the overall survival of patients aged ≥ 80 years who received perioperative chemotherapy was comparable to that of patients aged ≤ 79 years (P = 0.9795). In the multivariate analysis, the absence of perioperative chemotherapy was identified as an independent prognostic factor, while age ≥ 80 years was not. Perioperative chemotherapy was the sole independent prognostic factor in patients aged ≥ 80 years who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
Pancreaticoduodenectomy is safe for patients aged ≥ 80 years. The survival benefits of pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma aged ≥ 80 years might be limited to those who can receive perioperative chemotherapy.
由于人口老龄化，老年患者中行胰十二指肠切除术的频率正在增加。我们旨在阐明在患有多种基础疾病的80岁及以上患者中行胰十二指肠切除术的临床意义。
2010年4月至2021年3月在我院连续接受胰十二指肠切除术的649例患者，根据年龄分为两组：80岁及以上（51例）和79岁及以下（598例）。我们比较了两组之间的死亡率和发病率。对302例行胰十二指肠切除术治疗胰腺导管腺癌的患者进行了年龄相关预后分析。
两组之间在发病率（Clavien-Dindo分级III级或更高；P = 0.1300）、死亡率（P = 0.0786）或术后住院时间（P = 0.5763）方面无显著差异。因胰腺导管腺癌行胰十二指肠切除术的80岁及以上患者的总生存期短于79岁及以下患者（中位生存时间，16.7个月对32.7个月；P = 0.0206）。然而，接受围手术期化疗的80岁及以上患者的总生存期与79岁及以下患者相当（P = 0.9795）。在多变量分析中，未进行围手术期化疗被确定为独立预后因素，而80岁及以上年龄则不是。围手术期化疗是因胰腺导管腺癌行胰十二指肠切除术的80岁及以上患者的唯一独立预后因素。
胰十二指肠切除术对80岁及以上患者是安全的。对于80岁及以上胰腺导管腺癌患者，胰十二指肠切除术的生存获益可能仅限于能够接受围手术期化疗的患者。
