Ampullary tumours (ampullomas) in the elderly--an interdisciplinary problem.

Area of Science:

• Surgical Oncology
• Geriatric Surgery
• Gastroenterology

Background:

• Ampullary tumors, a type of periampullary tumor, generally have a better prognosis but are prone to early relapse.
• The safety and efficacy of pancreatoduodenectomy (PDE), also known as the Whipple operation, in elderly patients with periampullary tumors require further investigation.

Purpose of the Study:

• To evaluate the safety and feasibility of performing pancreatoduodenectomy (PDE) in patients over 65 years old diagnosed with periampullary tumors.
• To assess the post-operative outcomes and morbidity associated with PDE in the elderly population.

Main Methods:

• A retrospective analysis of 19 patients aged over 65 years (range 66-83) diagnosed with ampulloma between 2005 and 2007.
• Patients underwent either local surgical ampullectomy or pancreatoduodenectomy (PDE).

Main Results:

• Of the 19 patients, 6 had local ampullectomy and 13 underwent PDE.
• Among those who had PDE, tumor stages varied (T1, T2, T3, T4), with lymphatic involvement noted in 40% of T2 and all T3/T4 stages.
• One patient died from pulmonary embolism; 3 experienced post-operative complications including gastroenteroanastomosis and pancreatojejunoanastomosis dehiscence.

Conclusions:

• Pancreatoduodenectomy (PDE) can be safely performed in elderly patients (>65 years) with periampullary tumors, provided careful patient selection.
• Post-operative morbidity in this elderly cohort is significantly influenced by pre-existing multi-morbidity.
• Multimodal diagnosis and therapy are essential for managing ampullary tumors effectively.