Ann Hepatobiliary Pancreat Surg.  2018 May;22(2):128-135. 10.14701/ahbps.2018.22.2.128.

Oncologic outcomes after radical surgery for periampullary cancer in octogenarians

• Kim SH
• Chong JU
• Lim JH
• Chung MJ
• Park JY
• Bang SM
• Park SW
• Hwang HK
• Kang CM
• Lee WJ
• Kim KS

• KMID: 2412427
• DOI: http://doi.org/10.14701/ahbps.2018.22.2.128

Abstract

BACKGROUNDS/AIMS
Interest in treatments for elderly patients has increased with life expectancy, and various studies have reported on the safety and feasibility of radical surgery in elderly patients with cancer. Here, we investigated oncologic outcomes of periampullary cancer in octogenarians.
METHODS
We retrospectively reviewed medical records of 68 patients over 80 years of age who were diagnosed with periampullary cancer and were eligible for surgery; we analyzed overall survival (OS) and immediate postoperative complications and mortality.
RESULTS
There were no significant differences in mean age, disease type, oncologic features, comorbidities, or nutritional status between the patients who had surgery and those who did not. Five patients (20.0%) had major postoperative complications, but there was no immediate postoperative mortality. Patients who had surgery (n=25) had better OS (29.3 months; 95% confidence interval [CI]: 5.6-53.0) than did those who did not (n=43, OS: 7.6 months; 95% CI: 3.2-12.0 months; p<0.001). Similarly, patients with distal common bile duct cancer who underwent surgery had better OS than those who did not (surgery group: n=13, OS: 29.3 months, 95% CI: 8.9-49.7; non-surgery group: n=15, OS: 5.7 months, 95% CI: 4.2-7.2 months; p=0.002).
CONCLUSIONS
Radical surgery for octogenarian patients with periampullary cancer is safe, feasible, and expected to result in better survival outcomes, especially for patients with common bile duct cancer.

Keyword

Periampullary cancer; Octogenarian; Radical surgery; Oncologic outcome; Complication

MeSH Terms

Aged
Aged, 80 and over*
Common Bile Duct
Comorbidity
Humans
Life Expectancy
Medical Records
Mortality
Nutritional Status
Postoperative Complications
Retrospective Studies

Figure

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  Fig. 1 Age distribution of patients with periampullary cancer.

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  Fig. 2 Reasons for refusal of operation in Non-surgery group.

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  Fig. 3 (A) TNM stage and (B) complications in elderly patients after surgery in elderly patients with periampullary cancer at the duodenum, ampulla of Vater (AoV), pancreas and common bile duct.

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  Fig. 4 Overall survival rates of elderly patients with periampullary cancer; (A) Total, (B) common bile duct (CBD), (C) Pancreas, (D) Ampulla of Vater (AoV) and (E) Duodenum.

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