Is pancreaticoduodenectomy justified for septuagenarians and octogenarians?

Almost all of the studies described elderly as beginning at the age 70 and very few focused on the group of patients over 80 years of age. This study was undertaken to compare the surgical risk and prognosis between septuagenarians and octogenarians undergoing pancreaticoduodenectomy and to clarify whether or not pancreaticoduodenectomy is justified in octogenarians.

Among 276 patients with periampullary lesions undergoing pancreaticoduodenectomy between 1982 and 2000, octogenarians and septuagenarians were identified. The study concentrated on the surgical risks and outcomes.

There were 16 (6%) octogenarians and 82 (30%) septuagenarians among our 276 patients undergoing pancreaticoduodenectomy. Surgical mortality did not significantly increase in octogenarians (13%), as compared to septuagenarians (12%). Surgical morbidity was also similar in both groups (51% in octogenarians vs. 56% in septuagenarians). Octogenarians needed more frequent care in the intensive care unit (69%) postoperatively than septuagenarians (27%), p = 0.001. There was no significant difference in survival, (median survival = 16 months for septuagenarians and 17.6 months for octogenarians), p = 0.137. About half of each group (44.2% septuagenarians and 54.5% octogenarians) still died of the underlying periampullary lesions, p = 0.771.

Surgical risk did not significantly increase and prognosis was similar in octogenarians after pancreaticoduodenectomy, as compared to septuagenarians. Therefore, pancreaticoduodenectomy is justified not only in septuagenarians but also in octogenarians if carefully selected.