Ann Surg Treat Res.  2023 Aug;105(2):63-68. 10.4174/astr.2023.105.2.63.

Surgical management for elderly patients with pancreatic cancer

• Kim SW

• KMID: 2545156
• DOI: http://doi.org/10.4174/astr.2023.105.2.63

Abstract

Pancreatic cancer, one of the diseases of the elderly, has dismal prognosis, demanding major surgery with high risk and life quality problems, especially in the elderly. Therefore, treatment selection, whether or not to undergo surgery, preoperative risk assessment, and perioperative management of the elderly are becoming critical issues. Although the elderly are expected to have higher morbidity and mortality and lower long-term survival outcomes, surgery is becoming safer over time. Appropriate surgical indication selection, patient-centered decision-making, adequate prehabilitation and postoperative geriatric care are expected to improve surgical outcomes in the elderly. Surgeons must have the concept of geriatric care, and efforts based on institutional systems and academic societies are required. If well selected and prepared, the same surgical principle as non-elderly patients can be applied to elderly patients. In this paper, the surgical treatment of elderly patients with pancreatic cancer is reviewed.

Keyword

Elderly; Geriatric assessment; Pancreatectomy; Pancreatic cancer

Figure

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  Fig. 1 Preoperative risk assessment. ASA, American Society of Anesthesiology; ECOG, Eastern Cooperative Oncology Group; POSSIUM, Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity; CSHA, The Canadian Study of Health and Aging; CFS, clinical frailty scale; MSKFI, Memorial Sloan Kettering frailty index; SMI, Skeletal Muscle Index; GNRI, Geriatric Nutritional Risk Index; VES-13, The Vulnerable Elders Survey; E-PASS, Estimation of Physiologic Ability and Surgical Stress.

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  Fig. 2 Risk scoring/calculating systems, general and specific for pancreatectomy.

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  Fig. 3 Postoperative geriatric care that needs a multidisciplinary approach.

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