[Pancreatoduodenectomy in Octogenarian Patients and the Need for Standardized Evaluation].

Abstract

Pancreatoduodenectomy represents the only curative alternative in patients with periampullary tumors, currently with acceptable morbidity and mortality rates. However, there is little evidence in octogenarian patients.

Aim: To describe the experience of octogenarian patients undergoing pancreatoduodenectomy for tumors of the periampullary area at the Hospital Clínico de la Pontificia Universidad Católica de Chile.

Material and method: Retrospective study. All patients aged 80 years or older who underwent pancreatoduodenectomy for tumors in the periampullary area between 2002 and 2022 were included. Descriptive analysis and survival calculation with the Kaplan-Meier curve were performed.

Results: 24 patients were included. Median age 82 years (80-88); 62.5% were men. The tumor origin was 20 in the head of the pancreas (83.3%), 2 in the ampulla (8.3%), and 2 in the distal bile duct (8.3%), 100% of malignant origin. No patient received neoadjuvant treatment. 91.7% were classified as ASA II. 2 patients presented major complications, both of a medical nature. One patient presented with a type B pancreatic fistula. No patient presented hemorrhagic or biliary complications nor required reoperation or readmission. There was no postoperative mortality at 30 or 90 days. Adjuvant treatment was performed in 4 patients (16.7%). The 5-year overall survival was 20.1%, with a median of 22 months.

Conclusion: Pancreatoduodenectomy is an appropriate treatment alternative in patients over 80 years of age with tumors of the periampullary area, which can offer low morbidity and mortality rates if they are correctly selected in the context of a multidisciplinary preoperative evaluation in high-volume centers.