Higher Rate Of Surgical Complications Research Articles

An Exceedingly Rare Combination of Truncus Arteriosus and Total Anomalous Pulmonary Venous Connection

A neonate with truncus arteriosus (TA) and concomitant total anomalous pulmonary venous connection (TAPVC) is presented. The diagnosis of TA was made on antenatal ultrasound. An echocardiogram performed immediately after birth confirmed TA with a regurgitant quadrileaflet truncal valve. This echo further demonstrated all four pulmonary veins connected to a supracardiac confluence draining to the superior vena cava (SVC) via a partially obstructed ascending vein. Cardiac computed tomography confirmed TA and TAPVC, and demonstrated an ascending vein arising from the supracardiac confluence, passing over the aorta before inserting into the SVC. The patient underwent prompt single-stage repair. The postoperative course was complicated by a pulmonary embolism requiring surgical intervention, and severe truncal valve regurgitation necessitating a third surgery within the first 4 months of life. Review of the literature suggests this combination of defects is exceedingly rare and, of those cases reported, there is a high surgical and postsurgical complication rate.

Is there a "weekend effect" in kidney transplantation?

The ‘weekend effect’ describes increased adverse outcomes after weekend hospitalization.We examined weekend-weekday differences in the outcome of 580 patients following renal transplantation (RTx, brain dead donors) between January 2007 and December 2014 at our center. 3-year patient and graft survival, incidence of delayed graft function (DGF), acute rejections and estimated glomerular filtration rate (eGFR, CKD-EPI) at 1 year as well as surgical complications were assessed. Of all 580 transplants, 416 (71.7%) were performed on weekdays (Monday-Friday) and 164 (28.3%) on weekends (Saturday-Sunday). 3-year patient and graft survival, frequencies of DGF, acute rejections and 1-year eGFR as well as length of hospital stay were similar between RTx patients transplanted on weekdays or weekends, respectively. However, a noticeable difference was detected with regard to surgical complications which were more frequent in RTx patients transplanted on weekends. All results remained consistent across all definitions of weekend status. Our results suggest that weekend transplant status does not affect functional short-term and long-term outcomes after RTx. The standardized protocols and operationalized processes applied in RTx might contribute to this finding and may provide a model for other medical procedures that are performed on weekends to improve efficiency and outcomes. The higher rate of surgical complications after weekend RTx needs further elaboration to fully assess the presence of a weekend effect in RTx.

Comparison of Hepatectomy for Patients with Metabolic Syndrome-Related HCC and HBV-Related HCC

BackgroundMetabolic syndrome (MetS) is a group of clinicopathological manifestations. The outcome of liver surgery in metabolic syndrome-related hepatocellular carcinoma (MetS-HCC) still needs to be evaluated. We aim to clarify the outcomes following liver resection in patients with MetS-HCC compared those with hepatitis B virus-related HCC (HBV-HCC). MethodsAll the consecutive patients undergoing hepatectomy for HCC between January 2009 and December 2012 were retrospectively considered. Patients were divided into three groups: MetS-HCC, MetS-HBV-HCC, and HBV-HCC. Data on clinical characteristics, postoperative complications, and long-term outcome were collected and analyzed. ResultsA total of 1352 patients were included in this study. In MetS-HCC group, the severe morbidity rate was 33.33%, which was higher than that of HBV-HCC group (15.68%). In subgroup analysis, patients with MetS-HCC in American Joint Committee on Cancer (AJCC) stage I had superior DFS and OS when compared with those of the other two groups. ConclusionsWe should pay more attention to patients with MetS-HCC perioperatively due to the high rate of surgical complications. Nevertheless, curative treatment should be provided to patients with MetS.

Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

Background:Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction.Methods:Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion.Results:Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation.Conclusion:The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

The efficacy of surgical treatment of recurrent or persistent cervical cancer that develops in a previously irradiated field: a monoinstitutional experience.

There are no guidelines about the selection of recurrent cervical cancer patients for salvage surgery. Patients who developed recurrent or persistent cervical cancer in a previously irradiated field and were subsequently treated with salvage surgery (the surgery group) or palliative care alone (the palliative group) were identified. Patient characteristics, treatment-related complications, and survival were retrospectively compared between the two groups. A total of 79 patients (surgery group, n=51; palliative group, n=28) were identified. In the surgery group, no intraoperative complications or treatment-related deaths occurred. Eleven patients (21.6%) experienced severe postoperative complications. After a median follow-up period of 41.5months, 23 patients (45.1%) had developed recurrent disease, predominantly at distant sites, and 19 patients (37.3%) had died of disease progression. The estimated 3-year progression-free survival (PFS) and overall survival rates of the surgery group were 50.4 and 56.5%, respectively. In the palliative group, all of the patients died of disease progression. Positive surgical margins and lymph node metastasis were found to be independent prognostic factors for PFS in the surgery group. Among the patients with no or one poor prognostic factor, the patients in the surgery group survived significantly longer than those in the palliative group. However, among the patients with 2 poor prognostic factors, the surgery group and palliative group displayed similar survival periods. Salvage surgery is a curative treatment in recurrent or persistent cervical cancer patients. However, considering its high surgical complication rate, salvage surgery should only be offered to carefully selected patients.

Microsurgical reconstruction in mandible osteoradionecrosis: a clinical experience from Portugal

Osteoradionecrosis (ORN) is one of the most feared complications of head and neck cancer radiotherapy. The most common location for facial ORN is the mandible. Optimal clinical management is still under debate, insofar as a clear definition of its pathological process is yet to be obtained. Osseous surgical debridement is mandatory in advanced stages, but the reconstructive technique has to be specifically tailored to ORN characteristics. Data from patients with ORN treated in our institution from 2000 to 2014 was reviewed. Twenty-one patients were included. We retrospectively analyzed risk factors, severity of bone lesions, extension of bone resection, reconstructive option, and complications. A control group without ORN was used for comparison. In this study, radical excision and reconstruction with free flaps was the treatment of choice for moderate and severe ORN. We found a statistically significant higher rate of salvage procedures in ORN patients when compared with the control non-ORN cohort (p < 0.05). Sixty percent of the patients with ORN achieved stable coverage; 83.3% of the patients had evidence of bone union in imaging exams, and 75% recovered oral feeding capability. There was a tendency towards healing problems in ORN patients, but it did not reach statistical significance. Although there was a higher rate of surgical complications in ORN patients when compared to the control group, microsurgical approach leads to good morphofunctional results in moderate to severe ORN. Level of Evidence: Level IV, therapeutic study.

Exploring similarities and differences in hospital adverse event rates between Norway and Sweden using Global Trigger Tool

ObjectivesIn this paper, we explore similarities and differences in hospital adverse event (AE) rates between Norway and Sweden by reviewing medical records with the Global Trigger Tool (GTT).DesignAll acute care...

Update on Glucose Management Among Noncritically Ill Patients Hospitalized on Medical and Surgical Wards.

Hyperglycemia is a common issue affecting inpatient care. Although this is in part because of the higher rate of hospitalization among patients with preexisting diabetes, multiple factors complicate inpatient glucose management, including acute stress from illness or surgery, erratic dietary intake, and contribution of medications. It has been repeatedly demonstrated that poorly controlled blood glucose levels are associated with negative clinical outcomes, such as increased mortality, higher rate of surgical complications, and longer length of hospital stay. Given these concerns, there has been extensive study of the optimal strategy for management of glucose levels, with the bulk of existing literature focusing on insulin therapy in the intensive care unit setting. This review shifts the focus to the general adult medical and surgical wards, using clinical guidelines and sentinel studies to describe the scientific basis behind the current basal-bolus insulin-based approach to blood sugar management among noncritically ill inpatients. Patient-centered clinical trials looking at alternative dosing regimens and insulin analog and noninsulin agents, such as glucagon-like peptide-1 agonist therapies, introduce safe and effective options in the management of inpatient hyperglycemia. Data from these studies reveal that these approaches are of comparable safety and efficacy to the traditional basal-bolus insulin regimen, and may offer additional benefit in terms of less monitoring requirements and lower rates of hypoglycemia. Although existing data are encouraging, outcome studies will be needed to better establish the clinical impact of these more recently proposed approaches in an effort to broaden and improve current clinical practices in inpatient diabetes care.

Umbilical cord mesenchymal stem cells and their association with liver fibrosis

At present, the most effective therapeutic method for end-stage liver fibrosis is liver transplantation. However, the application of liver transplantation is limited by a shortage of liver donors, a high incidence rate of surgical complications, graft-versus-host disease, and high medical costs. Umbilical cord mesenchymal stem cell (UC-MSC) transplantation may become a promising method for the treatment of liver diseases. UC-MSCs are adult stem cells which exhibit multipotential differentiation and can differentiate into hepatic parenchymal cells. Due to their functions including immune regulation and secretion of trophic factors, UC-MSCs can inhibit immune response, promote hepatocyte regeneration, alleviate the progression of liver fibrosis, and improve liver function. In addition, compared with bone marrow mesenchymal stem cells, UC-MSCs have abundant sources, noninvasive collection, and high safety and thus they are attracting more and more attention. This article reviews the characteristics of UC-MSCs and their mechanism of action in the treatment of liver fibrosis, as well as risks of UC-MSCs therapy.

Comparison Study of Clinical Presentation and Surgical Outcome between Children and Adults with Craniopharyngioma: A 22-Year Single-Center Experience in Southern Taiwan

Background: The differences in clinical presentation and surgical outcome between children and adults with craniopharyngioma have not been well-described and there are few data available for Asian population. The aim of this study is to investigate the differences between paediatric and adult patients with craniopharyngioma at a single medical centre in southern Taiwan. Methods: The clinical records of 40 patients with craniopharyngioma who were all surgically treated at Kaohsiung Medical University Hospital from January 1990 to December 2012 were reviewed. The patients were divided into two groups based on age: children (= 20 years) and adults (>20 years). MRI and CT images were obtained pre- and post-operatively. Histopathological examination diagnosed tumors. Statistical analyses were performed to compare the differences in the two groups. Results: Among the patients, 17 were children and 23 were adults. The children group demonstrated more diagnoses of large or giant tumors (p<0.001), a higher rate of tumors with both solid and cystic composition (p=0.027) as well as adamantinomatous type tumors (p=0.020). The children group also had a higher surgical complication rate of diabetes insipidus (p=0.023). Conclusions: There are significant differences between children and adults with craniopharyngioma with regard to tumor size, histopathology type of tumor and hormone-related surgical complications. These findings are useful for improving the strategies for managing patients with craniopharyngioma.

Risk scores as useful predictors of perioperative complications in patients with rectal cancer who received radical surgery

BackgroundRectal cancer is associated with a higher rate of surgical complications. The ability to predict the risk of complications before treatment would facilitate the design of personalized treatment strategies optimally suited for each patient.MethodsWe retrospectively studied 260 patients with rectal cancer who underwent radical surgery to examine the relations between complications and 5 types of risk scores.ResultsComplications developed in 56 patients (21.5%). Nineteen patients had infectious complications, 16 had intestinal obstruction, and 12 had other complications. Twelve patients out of 187 patients who received low anterior resection had anastomotic leakage. Estimation of Physiologic Ability and Surgical Stress Comprehensive Risk Score (E-PASS CRS) and Neutrophil-to-lymphocyte Ratio (NLR) were significantly related to all complications, infectious complications, and anastomotic leakage. Surgical Apgar Score was significantly related to infectious complications. Prognostic Nutritional Index was significantly related to all complications and intestinal obstruction. Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity was significantly related to all complications, and infectious complications. A multivariate analysis showed that body-mass index, E-PASS CRS, and NLR were independent risk factors for anastomotic leakage. In particular, NLR was the only score that could be evaluated before surgery.ConclusionsFive types of risk scores were useful methods for evaluating the risks of complications in patients with rectal cancer. NLR is a score that can be evaluated before surgery and predicted the risk of anastomotic leakage, suggesting that it is useful for assessing the need for a diverting colostomy.

Surgical treatment of childhood hepatoblastoma in the Netherlands (1990-2013).

Achievement of complete surgical resection plays a key role in the successful treatment of children with hepatoblastoma. The aim of this study is to assess the surgical outcomes after partial liver resections for hepatoblastoma, focusing on postoperative complications, resection margins, 30-day mortality, and long-term survival. Chart reviews were carried out on all patients treated for hepatoblastoma in the Netherlands between 1990 and 2013. A total of 103 patients were included, of whom 94 underwent surgery. Partial hepatectomy was performed in 76 patients and 18 patients received a liver transplant as a primary procedure. In 42 of 73 (58%) patients, one or more complications were reported. In 3 patients, information regarding complications was not available. Hemorrhage necessitating blood transfusion occurred in 33 (45%) patients and 9 (12%) patients developed biliary complications, of whom 8 needed one or more additional surgical interventions. Overall, 5-year disease-specific survival was 82, 92% in the group of patients who underwent partial hepatectomy, and 77% in the group of patients who underwent liver transplantation. Partial hepatectomy after chemotherapy in children with hepatoblastoma offers good chances of survival. This type of major surgery is associated with a high rate of surgical complications (58%), which is not detrimental to survival.

Management of Spinal Deformity in Adult Patients With Neuromuscular Disease.

A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs. Patients with neuromuscular disease are susceptible to postoperative medical complications, such as delirium, epidural hematomas, pulmonary emboli, and cardiac events. Compared with outcomes in the typical patient with spinal deformity, postoperative outcomes in patients with neuromuscular disease have higher rates of surgical complications, such as instrumentation failure, proximal junctional kyphosis, loss of correction, and the need for revision surgery, regardless of the magnitude of surgical treatment.

Does the Use of Intraoperative Microelectrode Recording Influence the Final Location of Lead Implants in the Ventral Intermediate Nucleus for Deep Brain Stimulation?

To determine if the use of intraoperative microelectrode recording (MER) influences the final location of lead implant in deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM), and to evaluate the incidence of associated complications. The usefulness of intraoperative MER in DBS is debated, some centers suggesting it increases complications without additional benefit. We conducted a retrospective chart review of all patients who underwent VIM DBS with MER at the University of Texas Health Science Center in Houston from June 1, 2009 to October 1, 2013. Initial (MRI determined) and final (intraoperative MER determined) coordinates of implant were compared. To assess incidences of hemorrhagic and infectious complications, we reviewed postoperative CT scans and follow-up notes. Forty-five lead implants on 24 patients were reviewed. The mean age at implantation was 62.42years (range 18-83). The average duration from diagnosis to surgery was 21.5years (range 1-52). A statistically significant mean difference was observed in the superior-inferior plane (0.52±0.80mm inferiorly, p<0.05) and the anterior-posterior plane (0.45±0.86mm posteriorly, p<0.05). A non-statistically significant difference was also observed in the medial-lateral plane (0.02±0.15mm, p>0.05). One patient developed an infectious complication (4.2%) that required removal of leads; two patients had minimal asymptomatic intra-ventricular bleeding (8.3%). In our DBS center, intraoperative MER in VIM DBS implant does not seem to have a higher rate of surgical complications compared to historical series not using MER, and might also be useful in determining the final lead location.

Total hip replacement for neck of femur fracture: Comparing outcomes with matched elective cohort

IntroductionCurrent literature suggests that total hip replacement (THR) is superior to hemiarthroplasty (HA) for neck of femur fracture in selected group of patients. The outcomes of THR undertaken for trauma setting remain unclear when comparing with elective THR. We compared the outcomes of THR trauma cohort with best-matched elective cohort. MethodsWe retrospectively reviewed 102 patients that underwent THR due to trauma from 2011 to 2013. We had access to 90 cases with complete records. Another 90 matched elective cases were obtained from local arthroplasty database. The elective cases were matched for gender, surgical approaches, surgeon’s grade, types of implant, patient’s age at operation date of ±5 years and operation date of ±60days. Subsequently, the selection criteria were relaxed to patient’s age at operation date of ±10 years and operation date of ±60days. Unmatched cases were excluded. Complications and death rate were compared. ResultsThe average age for both cohorts was 70 years. The trauma cohort had statistically significant lower BMI and longer hospital stay (p=0.001). The Functional Comorbidity Index (FCI) and Charlson Age Comorbidity Index (CACI) were the same for both cohorts, reflecting an active patient selection for THR in our centre. The trauma cohort had higher surgical complication rate (9% vs 4%), particularly higher dislocation rate (7% vs 1%); and higher medical complication rate (32% vs 6%). These were consistent with the literature. Contrary to literature, the trauma cohort had six dislocations that five of them were done via anterolateral approach. Among the eight trauma cases with surgical complications, six cases were performed by trainees. The cause of surgical complications remains unclear due to the nature of retrospective study. The trauma cohort had higher death rate than the elective cohort (14% vs 4%), with one post-operative cardiac arrest in the trauma cohort. The rest were non-orthopaedic related deaths, ranging between four months to four years. ConclusionA more robust way of selecting trauma patients for THR is warranted to reduce morbidity and mortality. Follow-up for the trauma cohort is warranted, as the patients are likely to outlive the implants.

CRITERIA OF SURGICAL RISK IN PATIENTS WITH DIFFUSE LUNG EMPHYSEMA WITH LARGE AND GIANT BULLAS

The article presents an assessment of postoperative period in patients with diffuse lung emphysema with large and giant bullas on the basis of surgical risk criteria, which were developed for the patients with diffuse emphysema without bullas. Retrospective study determined the group of patients who had high rate of surgical complications after bullectomy. The patients (46) were divided into 2 groups and it depended on the initial condition of the patients. There was stated, that the main criterion of surgical risk was a decrease of the level of OFL lower than 20% of the proper level in patients with large and giant bullas.

Impact of Body Mass Index >50 on Cardiac Structural and Functional Characteristics and Surgical Outcomes After Bariatric Surgery.

Body mass index (BMI) ≥50.0kg/m2 has been associated with increased surgical complications and mortality. We assessed echocardiographic characteristics and bariatric surgery complications of patients with BMI ≥50.0kg/m2 vs. those in less severe obesity. A retrospective analysis in patients who underwent gastric bypass was performed. Pre-surgery structural characteristics analyzed included left atrial dimension (LA), left ventricle mass (LVM), LVM indexed for height2.7 (LVMI), and LV hypertrophy (LVH). Functional characteristics included LV diastolic and systolic function. Degree of obesity was correlated with cardiac parameters, comorbidities, and surgical complications. Data on 312 patients (75.3% women, age 39.3 ± 0.6years, BMI 50.2 ± 0.5kg/m2) were analyzed. Cardiac parameters on the basis of BMI (<50kg/m2 vs. ≥50kg/m2) were LA 39.6 ± 4.8 vs. 41.9 ± 5.2mm, LVM 161 ± 46 vs. 194 ± 56g, LVMI 43.6 ± 0.9 vs. 51.8 ± 1.3g/ht2.7, and systolic pulmonary pressure 43.7 ± 10.1 vs. 50.5 ± 11.3mmHg, respectively (all p < 0.001). LVMI was correlated with BMI (p < 0.001), 2-h glucose on a glucose tolerance test (p = 0.01), and ejection fraction (p = 0.01). Surgical complications were not different among groups. Presence of LVH was independently associated with BMI ≥50kg/m2 and female sex, after adjusting for age, diabetes, hypertension, and pulmonary hypertension. Body mass index ≥50kg/m2 was independently associated with female sex and LVH but not with hypertension, diabetes, or a higher rate of surgical complications.

A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Cranial–nasal–orbital communicating tumors involving the anterior and middle skull base are among the most challenging to treat surgically, with high rates of incomplete resection and surgical complications. Currently, there is no recognized classification of tumors with regard to the choice of surgical approaches. From January 2004 to January 2014, we classified 32 cranial–nasal–orbital communicating tumors treated in our center into three types according to the tumor body location, scope of extension and direction of invasion: lateral (type I), central (type II) and extensive (type III). This classification considerably facilitated the choice of surgical routes and significantly influenced the surgical time and amount of hemorrhage during operation. In addition, we emphasized the use of transnasal endoscopy for large and extensive tumors, individualized treatment strategies drafted by a group of multidisciplinary collaborators, and careful reconstruction of the skull base defects. Our treatment strategies achieved good surgical outcomes, with a high ratio of total resection (87.5 %, 28/32, including 16 cases of benign tumors and 12 cases of malignant tumors) and a low percentage of surgical complications (18.8 %, 6/32). Original symptoms were alleviated in 29 patients. The average KPS score improved from 81.25 % preoperatively to 91.25 % at 3 months after surgery. No serious perioperative complications occurred. During the follow-up of 3 years on average, four patients with malignant tumors died, including three who had subtotal resections. The 3-year survival rate of patients with malignant tumors was 78.6 %, and the overall 3-year survival rate was 87.5 %. Our data indicate that the simple classification method has practical significance in guiding the choice of surgical approaches for cranial–nasal–orbital communicating tumors and may be extended to other types of skull base tumors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-016-4003-8) contains supplementary material, which is available to authorized users.

Treatment results and prognostic factors for advanced squamous cell carcinoma of the head and neck treated with salvage surgery after concurrent chemoradiotherapy.

For primary organ preservation, concurrent chemoradiotherapy (CCRT) is performed for advanced squamous cell carcinoma of the head and neck (SCCHN). In this organ-preservation setting with CCRT, surgery is reserved as a salvage treatment in cases of locoregional failure after CCRT. The purpose of the study was to review our experience with salvage surgery after CCRT for patients with SCCHN and to evaluate the effectiveness and prognostic factors affecting survival. The records of patients with stage II-IVB SCC of the larynx, oropharynx, or hypopharynx treated with salvage surgery after CCRT between 1998 and 2012 were reviewed. A total of 645 patients with previously untreated, resectable SCC of the larynx, oropharynx, or hypopharynx received CCRT. Salvage surgery was performed for 78 of 225 patients with residual or recurrent tumors. The 5-year overall survival (OS) and disease-specific survival rates for patients who received salvage surgery were 61.0 and 65.5%, respectively. Stage IV, poorly differentiated, synchronous double cancer, and surgical complications were significant predictors of unfavorable OS on multivariate analysis. Postoperative complications were observed in 30 patients (38.5%). Salvage surgery is the best therapeutic option for failure after CCRT for SCCHN because of its good survival rate, although a high surgical complication rate is seen. Patients with initial stage IV tumors, poorly differentiated SCC, or synchronous double cancer are considered for further adjuvant treatment.

Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study

BackgroundThe increasing elderly population is an inevitable trend worldwide in developed countries. Therefore, we aimed to assess the experience of a tertiary pancreatic center with a very homogenous population comprising only patients diagnosed with PDAC of the pancreatic head in patients older than 75 years of age compared to their younger counterparts regarding the benefit in life expectancy and tumor biological aggressiveness. Methods300 patients underwent partial pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for PDAC of the pancreatic head between 2002 and 2012 and were evaluated with regard to their co-morbidities, clinicopathological and perioperative variables, postoperative morbidity, mortality and long term survival. Therefore, two groups according to the age at the procedure (A: <75 years, n = 241, B: ≥75 years, n = 59) were designed. ResultsThere were no differences between groups with regard to gender, performed procedure (PPPD or PD), operation time, blood loss, tumor invasiveness and grade of tumor differentiation, R-status, lymph node ratio, 30-day mortality, length of stay and adjuvant chemotherapy. Extended resections including total pancreatectomy were slightly more often performed in younger patients (p = 0.071) and trended toward a higher rate of surgical complications in patients <75 years of age (p = 0.183). A higher rate of preoperative co-morbidities in elderly patients (group B), was associated with more postoperative non-surgical complications (p = 0.002) in this group of patients. However, the median overall survival (19.2 vs. 18.4 months) did not differ significantly between groups. ConclusionsMajor pancreatic surgery for ductal adenocarcinoma of the pancreatic head is justified in elderly patients. With careful patients' selection and prudent perioperative management, elderly patients will have a similar long term outcome despite the higher rate of postoperative morbidity based on non-surgical complications.