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Dengsø KE, Berg A, Hansen CP, Burgdorf SK, Krohn PS, Sillesen M, Spiegelhauer N, Bach MT, Melton M, Nielsen B, Christensen BM, Finderup J, Hillingsø J. Have a vital end-user been overlooked? Developing a shared decision intervention for patients with potential pancreatic cancer regarding the choice of surgery. PEC INNOVATION 2024; 4:100269. [PMID: 38435237 PMCID: PMC10907832 DOI: 10.1016/j.pecinn.2024.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Objective To develop a patient decision aid facilitating shared decision making for patients with potential pancreatic cancer deciding about no treatment, surgical or medical treatment. Methods Based on a user-centred design by Wittemann et al., we developed a shared decision making intervention in three phases: 1) Understanding decision needs 2) Development of a patient decision aid (PtDA) based on a generic template 3) Assessment of the intervention from interviews with patients (n = 11), relatives (n = 11), nurses (n = 4) and surgeons (n = 2) analysed with thematic analysis, and measuring patients' perceptions of choice of options with the Decisional Conflict Scale. Results Results showed varying experiences with the use of the PtDA, with surgeons not finding PtDA useful as it was impractical and constraining with patients' conversations. There was no difference in patients' perceptions in choosing options for those being presented vs those patients not being presented for the PtDA. Conclusion The format and structure of the PtDA was not feasible for the surgeons as fundamental users in the present clinic. Innovation This study highlights the urgent need to consider clinical context before introducing a predefined tool and shows the importance of a multistakeholder approach. Research should focus on finding means to successful implement shared decision making.
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Affiliation(s)
- Kristine Elberg Dengsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Berg
- Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stefan K. Burgdorf
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Paul S. Krohn
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Sillesen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nina Spiegelhauer
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette Tholstrup Bach
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marianne Melton
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Betina Nielsen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Marcel Christensen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Denmark
| | - Jens Hillingsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Amini N, D'Adamo CR, Khashchuk D, Dodson R, Katlic M, Wolf J, Mavanur A. Accuracy of National Surgical Quality Improvement Program Risk Calculator Among Elderly Patients Undergoing Pancreas Resection. J Surg Res 2022; 279:567-574. [DOI: 10.1016/j.jss.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/12/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022]
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Burgdorf SK, Storkholm JH, Chen IM, Hansen CP. Postoperative and long-term survival in relation to life-expectancy after pancreatic surgery in elderly patients (cohort study). Ann Med Surg (Lond) 2021; 69:102724. [PMID: 34457257 PMCID: PMC8379474 DOI: 10.1016/j.amsu.2021.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background An evaluation of the outcome after pancreatic surgery with focus on post-operative and late survival in elderly patients was performed. Methods The study included 1.556 patients from a single HBP unit operated from 1. January 2010 to 31. December 2019. Patients were divided into two cohorts, < 75 years (n = 1.296) and ≥75 years (n = 260). Post-operative outcome was evaluated in all patients and late outcome in patients with adenocarcinoma in the pancreas (n = 765) and the duodenum (n = 117). The follow-up of patients with benign disease and adenocarcinoma was 57.95 (12.1–132.7) and 39.85 (12.0–131.7) months, respectively. Results Length of hospital-stay and surgical complications were not significantly different in the two cohorts, but in-hospital death was 1.1% (<75 years) and 3.5% (≥75 years) (p = 0.008). The median overall survival of adenocarcinoma was 29.7 (<75 years) and 24.3 months (≥75 years) (p = 0.3228) with a one, two, and five-years survival of 74.5%, 56.6% and 28.6% vs. 73.6%, 51.1%, and 25.5%. Median time to relapse (46.2% of patients <75 years and 40.5% of patients ≥75 years) was 9 (1 - 51) and 8 (1 - 78) months (p = 0.534), respectively. Adjuvant chemotherapy did not have impact on the survival of the old cohort. Patients who died during the observation period had lost 94% (<75 years) and 87% (≥75 years) of expected remnant life. Estimated years lost in the old cohort was 4.2 in males and 4.9 in females (p = 0.025) Conclusion Elderly patients may undergo pancreatic surgery with a low mortality and for adenocarcinoma with an acceptable long-term survival.
Surgery is the only potentially curable treatment to pancreatic cancer. Elderly patients may tolerate pancreatic surgery with low mortality. Radical pancreatic surgery improves long-term survival, also in elderly patients. Operability should be evaluated from morbidity and biological age. Pancreatic surgery in elderly should only be performed in high volume centers.
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Affiliation(s)
- S K Burgdorf
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
| | - J H Storkholm
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
| | - I M Chen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark
| | - C P Hansen
- Department of Surgery Rigshospitalet, University of Copenhagen, Denmark
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Tessman D, Chou J, Shebrain S, Munene G. Surgical Outcomes of Distal Pancreatectomy in Elderly Patients. Am Surg 2020; 88:115-119. [PMID: 33342301 DOI: 10.1177/0003134820982574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The extent to which age impacts surgical outcomes remains poorly characterized. This study aims to evaluate the impact of age on 30-day outcomes in patients after distal pancreatectomy. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2017), distal pancreatectomy patients were identified and age-stratified, groups A (≤75 years) and B (>75 years). Outcomes included 30-day mortality, morbidity, readmissions, operative time (min), and hospital length of stay (LOS, days). RESULTS Of 3042 total patients identified, 1686 (55.4%) were women. A total of 2649 patients (87.1%) were in group A. Overall, both groups had similar baseline characteristics with the exception of the following: diabetes mellitus (24.8% vs. 30.0%, P = .03), smoking (19.3% vs. 4.8%, P < .001), congestive heart failure (.5% vs. 1.8%, P = .010), hypertension (HTN) (47.9% vs. 72.5%, P < .001), bleeding disorders (3.1% vs. 5.3%, P = .036), the American Society of Anesthesiologists (ASA) (III-V) scores (67.6% vs. 85.5%, P < .001), and body mass index (29.2 [±6.7] vs. 27.4 [±5.6], P = .001).Deep surgical site infection was higher in group A (12.1% vs. 6.6%, P = .001), while acute renal failure (ARF) and postoperative myocardial infarction (MI) were higher in group B. 30-day readmissions were higher in group A (17.4% vs. 12.2%, P = .011) despite no statistically significant difference in LOS (7.10 [±6.36] vs. 7.30 [±4.93] days, P = .553) or overall morbidity (29.4% vs. 28.8%, P = .859). CONCLUSION(S) Those undergoing distal pancreatectomy experienced similar overall morbidity and mortality outcomes regardless of age. However, those older than 75 years had more cardiovascular risk factors, which may have contributed to their higher rates of postoperative ARF and MI.
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Affiliation(s)
- Derek Tessman
- Department of Surgery, 51374Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Jesse Chou
- Department of Surgery, 51374Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Saad Shebrain
- Department of Surgery, 51374Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Gitonga Munene
- Department of Surgery, 51374Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.,Western Michigan Cancer Center, Kalamazoo, MI, USA
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Liu Q, Zhao Z, Zhang X, Zhao G, Tan X, Gao Y, Lau WY, Liu R. Robotic pancreaticoduodenectomy in elderly and younger patients: A retrospective cohort study. Int J Surg 2020; 81:61-65. [PMID: 32750491 DOI: 10.1016/j.ijsu.2020.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/27/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic pancreaticoduodenectomy (RPD) has gradually been accepted as it has overcome some of the limitations of laparoscopic surgery. Outcomes following RPD in elderly patients are still uncertain. This study aimed to evaluate the safety and feasibility of RPD in elderly patients. METHODS The demographics and perioperative outcomes of a consecutive series of patients who underwent RPD between January 2018 and September 2019, were retrospectively analyzed. Patients were divided into 2 groups: elderly patients (≥75 years) and younger patients (<75 years). RESULTS Of 431 patients who were included in this study, 77 were elderly patients and 354 were younger patients. Elderly patients had a significantly higher ASA score than younger patients (P < 0.001). There were no significant differences in operative time, estimated blood loss and blood transfusion rate between groups (P > 0.05). Elderly patients had significantly higher morbidity and longer postoperative hospital stay than younger patients (49.3% vs. 31.1%, P = 0.002; 22.8 vs. 13.3 days, P < 0.001, respectively). However, the reoperation, 90-day readmission and mortality rates were comparable in the two groups (P > 0.05). Multivariate analysis demonstrated that a higher ASA score was the only independent factor for postoperative morbidity (OR 2.02, 95% CI 1.06-3.88, P = 0.03), while old age was not (OR 0.81, 95% CI 0.36-1.81, P = 0.80). CONCLUSION This study demonstrated that RDP was safe and feasible in elderly patients. Age should not be a contraindication to RPD. Elderly patients with careful patient selection should be considered for RPD.
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Affiliation(s)
- Qu Liu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhiming Zhao
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiuping Zhang
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Guodong Zhao
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xianglong Tan
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuanxing Gao
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Rong Liu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
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Di Franco G, Palmeri M, Guadagni S, Furbetta N, Gianardi D, Bronzoni J, Palma A, Bianchini M, Musetti S, Bastiani L, Caprili G, Biancofiore G, Mosca F, Di Candio G, Morelli L. Pancreatic resections in elderly patients with high American Society of Anesthesiologists' risk score: a view from a tertiary care center. Aging Clin Exp Res 2020; 32:935-950. [PMID: 31347102 DOI: 10.1007/s40520-019-01276-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/12/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases. AIM To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk. METHODS A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. RESULTS Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients. CONCLUSIONS Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.
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Affiliation(s)
- Gregorio Di Franco
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Niccolò Furbetta
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Desirée Gianardi
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Jessica Bronzoni
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Alessandro Palma
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Matteo Bianchini
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Serena Musetti
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Luca Bastiani
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - Giovanni Caprili
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | | | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy.
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy.
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Shatveryan GA, Chardarov NK, Nikoda VV, Bagmet NN, Tadzhibova IM, Lishova EA, Ratnikova NP, Karagyozyan GA. [Short-term results of pancreatoduodenectomy in patients over 70 years old]. Khirurgiia (Mosk) 2020:25-32. [PMID: 31994496 DOI: 10.17116/hirurgia202001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the immediate results of PDE in patients younger and older 70 years. MATERIAL AND METHODS The study included patients who underwent PDE for various indications from March 2010 to February 2019. All patients are divided into 2 groups: <70 years old and ≥70 years old. Primary endpoints were postoperative mortality and complication rate. RESULTS There were 110 procedures within 9 years. There were 93 patients aged <70 years (group 1) and 17 patients aged ≥70 years (group 2). ASA (American Society of Anesthesiologists) and PMP scores (Preoperative Mortality Predictor) were higher in group 2: 3 (2-3) vs 2 (1-3) (p=0,002) and 12 (6-15) vs 6.5 (5-15) (p<0.001), respectively. Mortality rate was higher in group 2 (11.7% vs. 3.2%) without statistical significance (p=0.16). Overall morbidity (72% vs 76%; p=1.0), incidence of major complications grade ≥IIIa (29% vs 29%), delayed gastric emptying B/C (17.2% vs 17.6%), pancreatic fistula grade B/C (23.6% vs 35.3%, p=0.3), biliary fistula grade B/C (7.5% vs 11.8%; p=0.62), postoperative hospital-stay [22 (8-165) days vs 23 (9-71) days; p=0.92] were comparable in both groups. CONCLUSION Short-term results of PDE in patients aged <70 and ≥70 years are comparable despite higher ASA and PMP scores in the group 2. General status and concomitant diseases should be considered during selection of patients with resectable tumors for PDE. Age per se is not a contraindication for surgery.
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Affiliation(s)
- G A Shatveryan
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - N K Chardarov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - V V Nikoda
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - N N Bagmet
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - I M Tadzhibova
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - E A Lishova
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - N P Ratnikova
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - G A Karagyozyan
- Petrovsky National Research Centre of Surgery, Moscow, Russia
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Liang Y, Zhao L, Jiang C, Hu P, Wang H, Cai Z, Wang W. Laparoscopic pancreaticoduodenectomy in elderly patients. Surg Endosc 2019; 34:2028-2034. [PMID: 31312964 DOI: 10.1007/s00464-019-06982-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of the study is to evaluate the safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients by short-term surgical effects. METHODS We retrospectively collected clinical data of 55 non-elderly patients (< 70 years), 27 elderly patients (≥ 70 years) underwent LPD, and 19 elderly patients underwent open pancreaticoduodenectomy (OPD) in biliopancreatic surgery department of Huadong Hospital, affiliated to Fudan University, from Jan 2015 to Jan 2018. Patients were divided into 3 groups: LPD aged < 70 years, LPD aged ≥ 70 years, and OPD aged ≥ 70 years, according to their age at admission and surgical approach in order to compare baseline characteristics and short-term surgical outcomes. RESULTS Totally 101 patients were included in this study; 59 cases were male; 42 cases were female; mean age was 66 years old. Elderly LPD patients seemed to have higher overall morbidity (41% vs. 20%, P = 0.05) compared to non-elderly patients. This difference is even more significant in our multivariable analysis model with an odds ratio of 4.48 (95% CI 1.31-17.87, P = 0.018). The 90-days mortality, operative time, estimated blood loss (EBL), and post-operative hospital stay (POHS) were similar in two groups. Elderly LPD patients had less EBL and shorter POHS than elderly OPD patients. However, the mortality and morbidity rate were comparable in these two groups. CONCLUSIONS Aging patients have higher overall morbidity than younger patients in LPD. However, for aging population who need to undergo pancreaticoduodenectomy, LPD might have some advantages over OPD.
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Affiliation(s)
- Yun Liang
- Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China
| | - Liting Zhao
- Department of Biliopancreatic Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China
| | - Chongyi Jiang
- Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China.
| | - Pengfei Hu
- Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China
| | - Hongwei Wang
- Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China
| | - Zhiwei Cai
- Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China
| | - Wei Wang
- Department of Biliopancreatic Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China.
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Kaman L, Chakarbathi K, Gupta A, Dahiya D, Singh K, Ramavath K, Behera A, Kajal K. Impact of Enhanced Recovery after Surgery protocol on immediate surgical outcome in elderly patients undergoing pancreaticoduodenectomy. Updates Surg 2019; 71:653-657. [PMID: 30673978 DOI: 10.1007/s13304-019-00625-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
Abstract
The numbers of patients undergoing pancreaticoduodenectomy are increasing and considerable percentage is elderly patients. Pancreaticoduodenectomy is a major and complicated surgery. The morbidity and mortality following pancreaticoduodenectomy have significantly reduced in recent times; it still remains unclear in elderly patients. Applications of Enhanced Recovery after Surgery protocol have contributed for this better outcome. In this retrospective study, patients who underwent pancreaticoduodenectomy with Enhanced Recovery after Surgery protocol were included and divided into two groups (< 60 years vs ≥ 60 years). The "elderly patients" (≥ 60 years) were defined based on the WHO definition for Indian subcontinent. Outcomes were analyzed in terms of postoperative morbidity, mortality and length of hospital stay. Total 103 patients underwent pancreaticoduodenectomy during the study period (January 2012-December 2017). The mean age was 56.6 ± 10.32 years. Fifty-six (54.37%) patients were aged < 60 years (young group) and 47 (45.63%) patients were aged ≥ 60 years (elderly group). There was no difference between the groups in terms of age, gender, co-morbidity, preoperative drainage and diagnosis. There was no significant difference in the morbidity and mortality (p > 0.05). Delayed gastric emptying was the most common complication which was 25.24% (21% vs 23.41%). Pancreatic fistula rate was 13.59% (8.9% vs 12.76%) and hemorrhage was 4.85% (5.4% vs 4.3%). Mortality was 4.85%. Postoperative hospital stay was comparable (14.7 days vs 15.3 days) (p = 0.164). Pancreaticoduodenectomy is a safe surgical procedure in elderly patients in comparison to young patients. Application of Enhanced Recovery after Surgery protocol can improve the outcome further.
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Affiliation(s)
- Lileswar Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Karikal Chakarbathi
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ashish Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kaptan Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Krishna Ramavath
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kamal Kajal
- Department of Anaesthesia, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Surgical outcomes of laparoscopic distal pancreatectomy in elderly and octogenarian patients: a single-center, comparative study. Surg Endosc 2018; 33:2142-2151. [DOI: 10.1007/s00464-018-6489-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022]
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11
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Castel-Kremer E, De Talhouet S, Charlois AL, Graillot E, Chopin-Laly X, Adham M, Comte B, Lombard-Bohas C, Walter T, Boschetti G. An onco-geriatric approach to select older patients for optimal treatments of pancreatic adenocarcinoma. J Geriatr Oncol 2018; 9:373-381. [DOI: 10.1016/j.jgo.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 01/23/2018] [Accepted: 03/13/2018] [Indexed: 12/20/2022]
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Chen YT, Ma FH, Wang CF, Zhao DB, Zhang YW, Tian YT. Elderly patients had more severe postoperative complications after pancreatic resection: A retrospective analysis of 727 patients. World J Gastroenterol 2018; 24:844-851. [PMID: 29467554 PMCID: PMC5807942 DOI: 10.3748/wjg.v24.i7.844] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/03/2018] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine the impact of aging on the short-term outcomes following pancreatic resection (PR) in elderly patients. METHODS A retrospective cohort study using prospectively collected data was conducted at the China National Cancer Center. Consecutive patients who underwent PR from January 2004 to December 2015 were identified and included. 'Elderly patient' was defined as ones age 65 and above. Comorbidities, clinicopathology, perioperative variables, and postoperative morbidity and mortality were compared between the elderly and young patients. Univariate and multivariate analyses were performed using the Cox proportional hazard model for severe postoperative complications (grades IIIb-V). RESULTS A total of 454 (63.4%) patients were < 65-years-old and 273 (36.6%) patients were ≥ 65-years-old, respectively. Compared to patients < 65-years-old, elderly patients had worse American Society of Anesthesiologists scores (P = 0.007) and more comorbidities (62.6% vs 32.4%, P < 0.001). Elderly patients had more severe postoperative complications (16.8% vs 9.0%, P = 0.002) and higher postoperative mortality rates (5.5% vs 0.9%, P < 0.001). In the multivariate Cox proportional hazards model for severe postoperative complications, age ≥ 65 years [hazard ratio (HR) = 1.63; 95% confidence interval (CI): 1.18-6.30], body mass index ≥ 24 kg/m2 (HR = 1.20, 95%CI: 1.07-5.89), pancreaticoduodenectomy (HR = 4.86, 95%CI: 1.20-8.31) and length of operation ≥ 241 min (HR = 2.97; 95%CI: 1.04-6.14) were significant (P = 0.010, P = 0.041, P = 0.017 and P = 0.012, respectively). CONCLUSION We found that aging is an independent risk factor for severe postoperative complications after PR. Our results might contribute to more informed decision-making for elderly patients.
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Affiliation(s)
- Ying-Tai Chen
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Cheng-Feng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dong-Bing Zhao
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ya-Wei Zhang
- Department of Surgery, Yale School of Medicine, New Haven, CT 06520, United States
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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13
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Long-Term Outcomes After Pancreatectomy for Pancreatic Ductal Adenocarcinoma in Elderly Patients: Special Reference to Postoperative Adjuvant Chemotherapy. World J Surg 2018; 42:2617-2626. [DOI: 10.1007/s00268-018-4496-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Shamali A, De’Ath HD, Jaber B, Abuawad M, Barbaro S, Hamaday Z, Abu Hilal M. Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy. Int J Surg 2017; 45:138-143. [PMID: 28782662 DOI: 10.1016/j.ijsu.2017.07.106] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]
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Pointer LS, Al-Qurayshi Z, Pointer DT, Kandil E, Slakey DP. Community health indicators associated with outcomes of pancreatectomy. Am J Surg 2017; 215:120-124. [PMID: 28335987 DOI: 10.1016/j.amjsurg.2017.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/26/2017] [Accepted: 02/05/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE This study evaluates the association of environmental, social and health risk factors in relation to outcomes of pancreatic surgery. METHODS Patients who underwent pancreatectomy with a 30 day postoperative follow up in Florida, New York and Washington states were identified using the State Inpatient Databases (SID) from 2010 to 2011. This data was merged with community health indicators complied from the County Health Ranking database. Fourteen community health indicators were used to determine higher risk communities. Communities were then divided into low and high risk communities based on a scoring system using accumulative community risk. RESULTS Among 3494 patients included recipients in high-risk communities were more likely African American (p < 0.001), younger (age 40-59; p = 0.001), and had Medicaid as primary insurance (p = 0.001). Management of patients in high-risk communities was associated with increased risk of postoperative complications (p < 0.001), ICU admissions (p < 0.001), increased length of stay (p < 0.001). CONCLUSION Health indicators from patients' communities are predictors of increased risk of perioperative complications for individuals undergoing pancreas surgery.
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Affiliation(s)
- Lauren Slakey Pointer
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Zaid Al-Qurayshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - David Taylor Pointer
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
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16
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Geessink NH, Schoon Y, van Herk HCP, van Goor H, Olde Rikkert MGM. Key elements of optimal treatment decision-making for surgeons and older patients with colorectal or pancreatic cancer: A qualitative study. PATIENT EDUCATION AND COUNSELING 2017; 100:473-479. [PMID: 28029569 DOI: 10.1016/j.pec.2016.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/21/2016] [Accepted: 10/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To identify key elements of optimal treatment decision-making for surgeons and older patients with colorectal (CRC) or pancreatic cancer (PC). METHODS Six focus groups with different participants were performed: three with older CRC/PC patients and relatives, and three with physicians. Supplementary in-depth interviews were conducted in another seven patients. Framework analysis was used to identify key elements in decision-making. RESULTS 23 physicians, 22 patients and 14 relatives participated. Three interacting components were revealed: preconditions, content and facilitators of decision-making. To provide optimal information about treatments' impact on an older patient's daily life, physicians should obtain an overall picture and take into account patients' frailty. Depending on patients' preferences and capacities, dividing decision-making into more sessions will be helpful and simultaneously emphasize patients' own responsibility. GPs may have a valuable contribution because of their background knowledge and supportive role. CONCLUSION Stakeholders identified several crucial elements in the complex surgical decision-making of older CRC/PC patients. Structured qualitative research may also be of great help in optimizing other treatment directed decision-making processes. PRACTICE IMPLICATIONS Surgeons should be trained in examining preconditions and useful facilitators in decision-making in older CRC/PC patients to optimize its content and to improve the quality of shared care.
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Affiliation(s)
- Noralie H Geessink
- Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands.
| | - Yvonne Schoon
- Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands.
| | - Hanneke C P van Herk
- Department of Geriatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
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17
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Sahakyan MA, Edwin B, Kazaryan AM, Barkhatov L, Buanes T, Ignjatovic D, Labori KJ, Røsok BI. Perioperative outcomes and survival in elderly patients undergoing laparoscopic distal pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:42-48. [PMID: 27794204 DOI: 10.1002/jhbp.409] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The outcomes following laparoscopic distal pancreatectomy (LDP) in elderly patients have not been widely reported to date. This study aimed to analyze perioperative and oncologic outcomes in patients aged ≥70 years (elderly group) and compare with those <70 years (non-elderly group). METHODS From April 1997 to September 2015, 402 consecutive patients with lesions in the body and tail of the pancreas underwent LDP at Rikshospitalet, Oslo University Hospital. RESULTS Of these, 118 (29.4%) were elderly, whereas 284 (70.6%) were non-elderly. Despite higher rate of comorbidities and American Society of Anesthesiologists score (P = 0.001 and 0.001, respectively), elderly patients had lower postoperative morbidity, pancreatic fistula (PF) and readmission rates, compared with non-elderly (P = 0.032, 0.001 and 0.025, respectively). Spleen-preserving LDP (SPLDP) resulted in similar postoperative outcomes in the two groups. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) were comparable to non-elderly in terms of median and 3-year survival (20.2 vs. 19 months (P = 0.94, log-rank) and 26.7% vs. 34.3%, respectively). CONCLUSIONS Both LDP and SPLDP are safe in patients aged ≥70 years, providing outcomes similar to those in younger group. Elderly patients with PDAC can benefit from LDP, since age itself is not associated with decreased survival after surgery.
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Affiliation(s)
- Mushegh A Sahakyan
- The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Bjørn Edwin
- The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
| | - Airazat M Kazaryan
- The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway
| | - Leonid Barkhatov
- The Interventional Centre, Oslo University Hospital, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Trond Buanes
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
| | - Dejan Ignjatovic
- Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway
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18
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Is a surgical approach justified for octogenarians with pancreatic carcinoma? Projecting surgical decision making for octogenarian patients. Am J Surg 2016; 212:896-902. [DOI: 10.1016/j.amjsurg.2015.12.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/10/2015] [Accepted: 12/02/2015] [Indexed: 12/28/2022]
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19
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Bakens MJ, van der Geest LG, van Putten M, van Laarhoven HW, Creemers GJ, Besselink MG, Lemmens VE, de Hingh IH. The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population-based analysis. Cancer Med 2016; 5:2825-2831. [PMID: 27671746 PMCID: PMC5083735 DOI: 10.1002/cam4.921] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 01/05/2023] Open
Abstract
Adjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer is currently considered standard of care. In this nationwide study, we investigated which characteristics determine the likelihood of receiving adjuvant chemotherapy and its effect on overall survival. The data were obtained from the Netherlands Cancer Registry. All patients alive 90 days after pancreatoduodenectomy for M0‐pancreatic cancer between 2008 and 2013 in the Netherlands were included in this study. The likelihood to receive adjuvant chemotherapy was analyzed by multilevel logistic regression analysis and differences in time‐to‐first‐chemotherapy were tested for significance by Mann–Whitney U test. Overall survival was assessed by Kaplan–Meier method and Cox regression analysis. Of the 1195 patients undergoing a pancreatoduodenectomy for pancreatic cancer, 642 (54%) patients received adjuvant chemotherapy. Proportions differed significantly between the 19 pancreatic centers, ranging from 26% to 74% (P < 0.001). Median time‐to‐first‐chemotherapy was 6.7 weeks and did not differ between centers. Patients with a higher tumor stage, younger age, and diagnosed more recently were more likely to receive adjuvant treatment. The 5‐year overall survival was significantly prolonged in patients treated with adjuvant chemotherapy—23% versus 17%, log‐rank = 0.01. In Cox regression analysis, treatment with adjuvant chemotherapy significantly prolonged survival compared with treatment without adjuvant chemotherapy. The finding that elderly patients and patients with a low tumor stage are less likely to undergo treatment needs further attention, especially since adjuvant treatment is known to prolong survival in most of these patients.
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Affiliation(s)
- Maikel J Bakens
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.,Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Lydia G van der Geest
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Magreet van Putten
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | | | | | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Valery E Lemmens
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ignace H de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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20
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Agalianos C, Dervenis C. Pancreatic surgery in the elderly: overcoming the prejudices. Ann Gastroenterol 2016; 29:101-2. [PMID: 27065723 PMCID: PMC4805729 DOI: 10.20524/aog.2016.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Christos Dervenis
- Department of Surgery, Konstantopouleion General Hospital of Athens (Christos Dervenis), Greece
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21
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Ansari D, Aronsson L, Fredriksson J, Andersson B, Andersson R. Safety of pancreatic resection in the elderly: a retrospective analysis of 556 patients. Ann Gastroenterol 2016; 29:221-225. [PMID: 27065736 PMCID: PMC4805744 DOI: 10.20524/aog.2016.0016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/14/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The safety of pancreatic resection for elderly patients is still controversial. We examined the postoperative morbidity and mortality in patients aged 75 years or more undergoing pancreatic resection. METHODS Patients undergoing pancreatic resection were studied retrospectively and the outcomes were compared between patients aged <75 and ≥75 years. RESULTS Of the 556 patients enrolled, 78 (14%) were ≥75 years old. Elderly patients had significantly more co-morbidities, especially cardiovascular pathology (P=0.005). Also, elderly patients had significantly lower body mass index prior to surgery (P=0.005). There were no significant differences in terms of surgical procedures and tumor types between age groups. The incidence of postoperative pancreatic fistula grade A was significantly lower in the elderly group (P=0.022), but no significant differences were noted in the overall morbidity or the incidence of postpancreatectomy hemorrhage, delayed gastric emptying, bile leakage, cardiac complications, pulmonary complications or septic complications. The 30-day mortality rate was similar between groups (0.8% vs. 1.3%; P=0.532). CONCLUSION Pancreatic resection is a safe option for selected elderly patients. Our study confirms that age alone should not preclude potentially curative surgical therapy.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Linus Aronsson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Joakim Fredriksson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Bodil Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University, and Skåne University Hospital, Lund, Sweden
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22
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Miyazaki Y, Kokudo T, Amikura K, Kageyama Y, Takahashi A, Ohkohchi N, Sakamoto H. Age does not affect complications and overall survival rate after pancreaticoduodenectomy: Single-center experience and systematic review of literature. Biosci Trends 2016; 10:300-6. [PMID: 27396698 DOI: 10.5582/bst.2016.01093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Takashi Kokudo
- Division of Gastroenterological Surgery, Saitama Cancer Center
| | - Katsumi Amikura
- Division of Gastroenterological Surgery, Saitama Cancer Center
| | - Yumiko Kageyama
- Division of Gastroenterological Surgery, Saitama Cancer Center
| | - Amane Takahashi
- Division of Gastroenterological Surgery, Saitama Cancer Center
| | - Nobuhiro Ohkohchi
- Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba
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23
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Hospital of diagnosis and likelihood of surgical treatment for pancreatic cancer. Br J Surg 2015; 102:1670-5. [DOI: 10.1002/bjs.9951] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/25/2015] [Accepted: 08/25/2015] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Surgical resection for pancreatic cancer offers the only chance of cure. Assessment of the resectability of a pancreatic tumour is therefore of great importance. The aim of the study was to investigate whether centre of diagnosis influences the likelihood of surgery and whether this affects long-term survival.
Methods
Patients diagnosed with non-metastasized pancreatic cancer (M0) between 2005 and 2013 in the Netherlands were selected from the Netherlands Cancer Registry. Hospitals were classified as a pancreatic centre (at least 20 resections/year) or a non-pancreatic centre (fewer than 20 resections/year). The relationship between centre of diagnosis and likelihood of surgery was analysed by multivariable logistic regression. Influence of centre on overall survival was assessed by means of multivariable Cox regression analysis.
Results
Some 8141 patients were diagnosed with non-metastasized pancreatic cancer, of whom 3123 (38·4 per cent) underwent surgery. Of the 2712 patients diagnosed in one of 19 pancreatic centres, 52·4 per cent had exploratory laparotomy compared with 31·4 per cent of 5429 patients diagnosed in one of 74 non-pancreatic centres (P < 0·001). A pancreatectomy was performed in 42·8 and 24·6 per cent of the patients respectively (P < 0·001). Multivariable analysis revealed that patients diagnosed in a pancreatic centre had a higher chance of undergoing surgery (odds ratio 2·21, 95 per cent c.i. 1·98 to 2·47). Centre of diagnosis was not associated with improved long-term survival (hazard ratio 0·95, 95 per cent c.i. 0·91 to 1·00).
Conclusion
Patients with non-metastasized pancreatic cancer had a greater likelihood of having surgical treatment when the diagnosis was established in a pancreatic centre.
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24
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Santema TB, Visser A, Busch ORC, Dijkgraaf MGW, Goslings JC, Gouma DJ, Ubbink DT. Hospital costs of complications after a pancreatoduodenectomy. HPB (Oxford) 2015; 17:723-31. [PMID: 26082095 PMCID: PMC4527858 DOI: 10.1111/hpb.12440] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A pancreatoduodenectomy (PD) is a highly advanced procedure associated with considerable post-operative complications and substantial costs. In this study the hospital costs associated with complications after PD were assessed. METHODS A retrospective cohort study was conducted on 100 consecutive patients who underwent a pylorus-preserving (PP)PD between January 2012 and July 2013. Per patient, all complications occurring during admission or in the 30-day period after discharge were documented. All hospital costs related to the (PP)PD were defined as the costs of all medical interventions and resources during the hospitalisation period as recorded by the electronic supply tracking system. RESULTS The median hospital costs ranged from €17 482 for a patient without complications to €55 623 for a patient with a post-operative haemorrhage. A post-operative haemorrhage was associated with a 39.6% increase in total hospital costs after adjusting for patient characteristics. Other factors significantly associated with an increase in total hospital costs were: the presence of a malignancy other than a pancreatic adenocarcinoma (29.4% cost increase), the severity grade of a complication (34.3-70.6% increase) and the presence of a post-operative infection (32.4% increase). CONCLUSIONS This study provides an in-depth analysis of hospital costs and identifies factors that are associated with substantial cost consequences of specific complications occurring after a PD.
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Affiliation(s)
- Trientje B Santema
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands,Correspondence Trientje B. Santema, Department of Surgery, Room G4-130, Academic Medical Center, P.O. box 22660, 1100 DD Amsterdam, The Netherlands. Tel.: +31 20 566 4577. Fax: +31 20 566 6569. E-mail:
| | - Annelies Visser
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands
| | - Olivier R C Busch
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands
| | | | - J Carel Goslings
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands
| | - D J Gouma
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Academic Medical CenterAmsterdam, The Netherlands
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25
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Frakes JM, Strom T, Springett GM, Hoffe SE, Balducci L, Hodul P, Malafa MP, Shridhar R. Resected pancreatic cancer outcomes in the elderly. J Geriatr Oncol 2014; 6:127-32. [PMID: 25555451 DOI: 10.1016/j.jgo.2014.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/15/2014] [Accepted: 11/20/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine if age affects outcome in patients with resected pancreatic head cancer. MATERIALS AND METHODS An IRB-approved pancreatic cancer database was queried for patients with upfront resected pancreatic head cancer treated at our institution between 2000 and 2012. Overall survival (OS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS We identified 193 patients. Patients ≥70 years were less likely to receive adjuvant treatment (p = 0.002); however there were no other significant differences between age groups. There was a trend towards increased pancreatic leaks in the elderly group (p = 0.06), but no difference in post-operative complications or mortality. There was no difference in overall survival based on age. Median and 5-year OS were 23 months and 26.7% in patients <70 years, 23.4 months and 23% in those 70-75, 16.1 months and 0% in those 76-80, and 18.7 months and 15.4% in those >80 years (p = 0.62). On univariate analysis, there was increased OS in patients with lower T stage, N0 status, post-operative CA19-9 level <90, and use of chemoradiotherapy (p< 0.05). Multivariate analysis revealed that lower tumor stage, N0, post-operative CA19-9 level <90, and use of any adjuvant therapy predicted decreased mortality (p < 0.05). Age, gender, tumor site, tumor grade, and positive margins were not prognostic on multivariate analysis. CONCLUSIONS There is no difference in outcomes when comparing elderly patients with resected pancreatic cancer to those patients <70 years of age.
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Affiliation(s)
- Jessica M Frakes
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sarah E Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Pamela Hodul
- Gastrointestinal Tumor Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Mokenge P Malafa
- Gastrointestinal Tumor Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA.
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