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.
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.
Cir Esp (Engl Ed). 2023 Sep;101(9):599-608. doi: 10.1016/j.cireng.2022.10.018. Epub 2023 Aug 2.
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.
This is a retrospective and comparative trial, comparing results for CPD performed on 30 patients ≥80 years with PC and 159 patients <80 years.
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.
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.
目前的文献支持这样一种观点，即对于胰腺癌（PC）患者，施行头侧胰十二指肠切除术（CPD）治疗与中位生存期的延长相关，这一结论在 80 岁及以上（≥80 岁）患者以及年龄较小的患者中均成立。
这是一项回顾性比较研究，比较了 30 例≥80 岁的 PC 行 CPD 患者和 159 例<80 岁患者的结果。
80 岁以上组患者术前心血管发病率更高，肿瘤侵袭性更强，包括更显著的术前贫血、黄疸和 CA 19-9 水平升高、更高的血管和神经侵犯，以及尽管采用相同的手术技术，但 R0 切除率更低。两组患者术后并发症无显著差异。两组术后死亡率相似（80 岁以上患者为 3.3%，<80 岁患者为 3.1%）。随访期间死亡的主要原因是肿瘤复发、心血管并发症和 2 例老年患者的 COVID-19。<80 岁患者的 1、3 和 5 年生存率明显高于 80 岁以上患者（分别为 85.9%、61.1%和 39.2%，72.7%、28.9%和 9.6%；P=0.001）。CPD 术后 90 天内死亡与胰瘘的发生和是否使用外引流支架显著相关。
80 岁以上患者和<80 岁患者行 CPD 后的发病率和死亡率相似，但由于肿瘤侵袭性更强以及与年龄相关的合并症更多，导致长期生存时间更短。
