Pancreaticogastrostomy reconstruction is suitable for patients 79 years and older in pancreaticoduodenectomy: single center's experience

Abstract

Background and aim: The age of patients who received pancreaticoduodenectomy (PD) has been elevating. However, clinical features of elderly patients with cancer who received PD are unclear. This study analyzed the outcomes of PD in patients > or =79 year of age. Patients and methods: We studied 33 patients who had received PD in our center between 2005 and 2017.The patients were divided into two groups based on reconstruction type: Pancreaticogastrostomy (PG:n = 16) and pancreaticojejunostomy (PJ:n = 17) groups. We compared these two groups clinically. Elderly candidates of PD fulfilled performance status 0 or 1. Results: In all patients, mortality was 0.6% (2 patients of PJ group) and morbidity (Clavien-Dindo 2 = or <) was 70%. Median survival was 23 months. There was no significant difference in the incidence of complications including postoperative pancreatic fistula and the duration of postoperative hospital stay between two groups. Operating time and amount of operative blood loss of PG were less than these of PJ group (p < 0.05). Risk factors of survival of all patients were PJ, presence of combined resection, blood loss and worsen of activities of daily living (ADL). Among them, worse of ADL was the independent risk factor. Moreover, risk factor of worse of ADL was presence of combined resection (p < 0.05). Cumulative postoperative survival of PG was significant better than that of PJ group (p < 0.05). Conclusion: PD for selected elderly patients is acceptable. With regards to survival, less invasive and safe management is a first priority for elderly patients. PG can be one of feasible and important reconstruction options.