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Abstract
Introduction. Treatment of elderly patients with malignant neoplasms is a complex problem due to general comorbidity and reduced reserve capacity of the patient's body. All this results in a high risk of surgical complications and postoperative mortality.
Aim. To evaluate the tolerability of pancreaticoduodenectomy and the oncological feasibility of this operation in elderly patients aged 75 years and older.
Materials and Methods. The study included 73 elderly patients who underwent pancreaticoduodenectomy for malignant neoplasms of various localizations between January 2011 and April 2024.
Results. Postoperative complications occurred in 46 (63 %) patients, of which 25 (34.2 %) were class III or higher according to the Clavien-Dindo classification. The incidence of pancreatico-digestive anastomosis failure was 15.1 % and biliodigestive anastomosis failure was 12.3 %. Frequency of pancreatic fistula: type B — 12.3 %, C — 9.6 %. The postoperative mortality rate was 12.3 %. Independent factors for postoperative mortality were: relaparotomy (77.8 % vs. 0 %, p < 0.001), age over 79 years (p = 0.038), intraoperative blood loss more than 800 ml (p = 0.032), failure of pancreatico-digestive anastomosis (66.7 % vs. 7.8 %, p < 0.001), failure of biliodigestive anastomosis (44.4 vs. 7.8 %, p = 0.011), erosive bleeding in the area of surgery (55.6 % vs. 0 %, p < 0.001). The median OS for ductal carcinoma of the pancreatic head was 23 months, and the five-year OS was 17.8 %. The only independent factor that positively influenced OS was adjuvant chemotherapy (HR 0.3; 95 % CI 0.11-0.84, p = 0.022). The median OS in patients with ductal carcinoma of the pancreatic head after combined treatment with adjuvant chemotherapy reached 47 months (95 % CI: 11.00-∞), the five-year OS was 27.2 %, (p = 0.017).
Conclusion. Pancreaticoduodenectomy in the elderly is associated with a high postoperative mortality rate (12.3 %), even when performed in specialized centers, but its oncological justification seems convincing, as these operations allow survival rates comparable to those in the general population.
References
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