Feasibility and Results of Radical Surgery and Adjuvant Therapy in Patients Older than 70 Years with Pancreatic Adenocarcinoma
Creators: name: Gavazzi, Francesca
name: Ridolfi, Cristina
name: Bozzarelli, Silvia
name: Tronconi, Chiara
name: Angiolini, Maria Rachele
name: Rimassa, Lorenza
name: Montorsi, Marco
name: Zerbi, Alessandro
Publisher: name: JOP. Journal of the Pancreas
Year: 2013
Subjects: Meeting Abstracts; Pancreas

description: <strong>Context</strong> High morbidity rates following pancreatic surgery and adverse effects of chemo-radiation treatments still make surgeons and oncologist reluctant to candidate elderly patients to these surgical or medical therapies. <strong>Objective</strong> Evaluation of postoperative outcomes and adjuvant chemo-radiation protocols adherence among over 70-year-old patients with pancreatic adenocarcinoma (PDAC) treated in a referral center for pancreatic disease. <strong>Methods </strong>Between January 2010 and May 2013 we performed 161 pancreatic resection for PDAC (including invasive IPMN): 106 pancreatico­duodenectomies (PD), 44 left spleno-pancreatectomies (LP), and 11 total pancreatectomies (TP). In the present study we focused on over 70-year-old patients treated with surgery and, successively, candidate or not to adjuvant therapy. We prospectively recorded data about perioperative outcomes as well as patient’s adherence to planned chemo-radiation schedules. <strong>Results </strong>In our series over 70-year-old patients were 75 (47.2%). Median age at surgery was 76 years (range: 70-85 years). Thirty-one patients (41.3%) had ASA ≥3. Mean BMI was 23.6 kg/m<sup>2</sup>. Forty-seven patients received PD, 21 had LP, 7 underwent TP. Overall morbidity was 48% (Clavien Dindo ≥3: 12%); POPF was 13.3% (ISGPF B-C: 4.4%); biliary fistula rate was 5.5%; DGE rate was nihil; PPH was 5.3% (4 cases, 2 of them requiring reintervention); medical complications were 14.5%; reintervention were 5.3% (4 cases); mortality was 1.3% (1 case). Median LOS was 10 days (range: 5-31 days). Patients candidate for adjuvant treatment were 39 (52.0%): 25 chemotherapy (64.1%), 6 radiotherapy (15.4%), 8 combined chemo-radiation (20.5%). Of the other patients, 27 (36.0%) were not enrolled in any adjuvant schedule after surgery, 8 (10.7%) resulted stage 0-I at histology and 1 (1.3%) died during surgical hospitalization. Among patient undergoing chemotherapy, 70% received gemcitabine, 9% PEX-G, and 6% GemOx. Thirty-three percent of the patients experienced low grade toxicity (G1-2), while 18% had high grade (G3-4). Twelve percent<strong> </strong>of the patients could not complete the schedule because of toxicity or disease progression during the treatment. Median survival after surgery was 25 months. <strong>Conclusions</strong> The morbidity and mortality rate we observed in elderly patients is acceptable and aligned with data reported in larger series. In a similar way, adjuvant treatments toxicity appeared limited, and patients adherence to scheduled therapy adequate. An accurate preoperative and postoperative asses­sment, referring to biological more than chronological age, is mandatory in evaluation of cases eligible to surgery and adjuvant treatments.
description: JOP. Journal of the Pancreas, Vol 14, N° 5S (2013): September (Suppl.) - p. 528-602