دورية أكاديمية
أعرض في EDS

Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis.

التفاصيل البيبلوغرافية
العنوان: Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis.
المؤلفون: Henry AC; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Schouten TJ; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Daamen LA; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Walma MS; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Noordzij P; Department of Anesthesiology and Intensive Care, St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands., Cirkel GA; Department of Medical Oncology, Regional Academic Cancer Center Utrecht, Meander Medical Center Amersfoort, University Medical Center Utrecht, Utrecht, The Netherlands., Los M; Department of Medical Oncology, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht, The Netherlands., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Busch OR; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands., van Dam RM; Department of Surgery, Maastricht UMC+, Maastricht, The Netherlands., Festen S; Department of Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands., Groot Koerkamp B; Department of Surgery, Erasmus MC, Rotterdam, The Netherlands., van der Harst E; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands., de Hingh IHJT; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Kazemier G; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Liem MS; Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands., de Meijer VE; Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands., Nieuwenhuijs VB; Department of Surgery, Isala, Zwolle, Zwolle, The Netherlands., Roos D; Department of Surgery, Reinier de Graaf Group, Delft, The Netherlands., Schreinemakers JMJ; Department of Surgery, Amphia Hospital, Breda, The Netherlands., Stommel MWJ; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Molenaar IQ; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., van Santvoort HC; Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. h.vansantvoort@umcutrecht.nl.
مؤلفون مشاركون: Dutch Pancreatic Cancer Group
المصدر: Annals of surgical oncology [Ann Surg Oncol] 2022 Sep; Vol. 29 (9), pp. 6031-6042. Date of Electronic Publication: 2022 Jun 02.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE
أسماء مطبوعة: Publication: 2005- : New York, NY : Springer
Original Publication: New York, NY : Raven Press, c1994-
مواضيع طبية MeSH: Pancreatic Neoplasms*/drug therapy , Pancreatic Neoplasms*/surgery, Aged ; Chemotherapy, Adjuvant ; Humans ; Pancreatectomy ; Pancreatic Hormones ; Prospective Studies ; Retrospective Studies ; Pancreatic Neoplasms
مستخلص: Background: The number of elderly patients with pancreatic cancer is growing, however clinical data on the short-term outcomes, rate of adjuvant chemotherapy, and survival in these patients are limited and we therefore performed a nationwide analysis.
Methods: Data from the prospective Dutch Pancreatic Cancer Audit were analyzed, including all patients undergoing pancreatic cancer resection between January 2014 and December 2016. Patients were classified into two age groups: <75 and ≥75 years. Major complications (Clavien-Dindo grade 3 or higher), 90-day mortality, rates of adjuvant chemotherapy, and survival were compared between age groups. Factors associated with start of adjuvant chemotherapy and survival were evaluated with logistic regression and multivariable Cox regression analysis.
Results: Of 836 patients, 198 were aged ≥75 years (24%) and 638 were aged <75 years (76%). Median follow-up was 38 months (interquartile range [IQR] 31-47). Major complications (31% vs. 28%; p = 0.43) and 90-day mortality (8% vs. 5%; p = 0.18) did not differ. Adjuvant chemotherapy was started in 37% of patients aged ≥75 years versus 69% of patients aged <75 years (p < 0.001). Median overall survival (OS) was 15 months (95% confidence interval [CI] 14-18) versus 21 months (95% CI 19-24; p < 0.001). Age ≥75 years was not independently associated with OS (hazard ratio 0.96, 95% CI 0.79-1.17; p = 0.71), but was associated with a lower rate of adjuvant chemotherapy (odds ratio 0.27, 95% CI 0.18-0.40; p < 0.001).
Conclusions: The rate of major complications and 90-day mortality after pancreatic resection did not differ between elderly and younger patients; however, elderly patients were less often treated with adjuvant chemotherapy and their OS was shorter.
(© 2022. The Author(s).)
التعليقات: Comment in: Ann Surg Oncol. 2022 Sep;29(9):6043-6044. (PMID: 35616745)
References: Netherlands Cancer Registry (NCR): Dutch cancer figures. 2019. Available at: http://www.cijfersoverkanker.nl/ . Accessed 10 Sep 2020.
Beltrame V, Gruppo M, Pastorelli D, et al. Outcome of pancreaticoduodenectomy in octogenerians: single institution’s experience and review of the literature. J Visc Surg. 2015;152:279–84. (PMID: 2611730310.1016/j.jviscsurg.2015.06.004)
van der Geest LG, Besselink MG, van Gestel YR, Busch OR, de Hingh IH, de Jong KP, Lemmens VE. Pancreatic cancer surgery in elderly patients: balancing between short-term harm and long-term benefit. A population-based study in the Netherlands. Acta Oncol. 2016;55(3):278–85. (PMID: 2655284110.3109/0284186X.2015.1105381)
Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Bachet JB. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395–406. (PMID: 3057549010.1056/NEJMoa1809775)
Latenstein AEJ, van der Geest LGM, Bonsing BA, et al. Dutch Pancreatic cancer group: nationwide trends in incidence, treatment and survival of pancreatic ductal adenocarcinoma. Eur J Cancer. 2020;125:83–93. (PMID: 3184179210.1016/j.ejca.2019.11.002)
Krautz C, Nimptsch U, Weber GF, Mansky T, Grutzmann R. Effect of hospital volume on inhospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg. 2018;267:411–7. (PMID: 2837987110.1097/SLA.0000000000002248)
Lidsky ME, Sun Z, Nussbaum DP, Adam MA, Speicher PJ, Blazer DG 3rd. Going the extra mile: improved survival for pancreatic cancer patients traveling to high-volume centers. Ann Surg. 2017;266(2):333–8. (PMID: 2742902010.1097/SLA.0000000000001924)
Shamali A, DeAth HD, Jaber B, Abuawad M, Barbaro S, Hamaday Z, Hilal MA. Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy. Int J Surg. 2017;45:138–43. (PMID: 2878266210.1016/j.ijsu.2017.07.106)
Paiella S, De Pastena M, Pollini T, et al. Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center. World J Gastroenterol. 2017;23(17):3077–83. (PMID: 28533664542304410.3748/wjg.v23.i17.3077)
Kim SY, Fink MA, Perini M, et al. Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy. ANZ J Surg. 2018;88(5):E445–50. (PMID: 2859370810.1111/ans.14039)
Tan E, Song J, Lam S, D’Souza M, Crawford M, Sandroussi C. Postoperative outcomes in elderly patients undergoing pancreatic resection for pancreatic adenocarcinoma: a systematic review and meta-analysis. Int J Surg. 2019;72:59–68. (PMID: 3158091910.1016/j.ijsu.2019.09.030)
Satoi S, Yamamoto T, Uchida K, et al. Optimal treatment for octogenerians with resectable and borderline resectable pancreatic ductal adenocarcinoma: a multicenter retrospective study. Pancreas. 2020;49(6):837–44. (PMID: 3259061910.1097/MPA.0000000000001579)
Lu L, Zhang X, Tang G, et al. Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: a population-based retrospective cohort study of 4,283 patients. Int J Surg. 2018;53:262–8. (PMID: 2960435210.1016/j.ijsu.2018.03.054)
Sukharamwala P, Thoens J, Szuchmacher M, et al. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford). 2012;14(10):649–57. (PMID: 2295400010.1111/j.1477-2574.2012.00506.x)
Renz BW, Khali PN, Mikhailov M, et al. Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: a retrospective cohort study. Int J Surg. 2016;28:118–25. (PMID: 2690632910.1016/j.ijsu.2016.02.064)
Marmor S, Burke EE, Virnig BA, et al. A comparative analysis of survival outcomes between pancreatectomy and chemotherapy for elderly patients with adenocarcinoma of the pancreas. Cancer. 2016;122:3378–85. (PMID: 2741938210.1002/cncr.30199)
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(7):844–51. (PMID: 29467554580794210.3748/wjg.v24.i7.844)
Casadei R, Ricci C, Lazzarini E, Taffurelli G, D’Ambra M, Mastroroberto M. Pancreatic resection in patients 80 years or older: a meta-analysis and systematic review. Pancreas. 2014;43(8):1208–18. (PMID: 2533340510.1097/MPA.0000000000000182)
Watanabe Y, Shinkawa T, Endo S, Abe Y, Nishihara K, Nakano T. Long-term outcomes after pancreatectomy for pancreatic ductal adenocarcinoma in elderly patients: special reference to postoperative adjuvant chemotherapy. World J Surg. 2018;42(8):2617–26. (PMID: 2938342910.1007/s00268-018-4496-y)
Shin SH, Park Y, Hwang DW, et al. Prognostic value of adjuvant chemotherapy following pancreaticoduodenectomy in elderly patients with pancreatic cancer. Anticancer Res. 2019;39(2):1005–12. (PMID: 3071198810.21873/anticanres.13206)
Malik AK, Lamarca A, Siriwardena AK, et al. The influence of patients’ age on the outcome of treatment for pancreatic ductal adenocarcinoma. Pancreas. 2020;49(2):201–7. (PMID: 3201153510.1097/MPA.0000000000001486)
Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248(3):459–67. (PMID: 1879136610.1097/SLA.0b013e318185e1b3)
Yuan L, Chang M, Wang J. Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis. Age Ageing. 2021;50:1118–28. (PMID: 3369347210.1093/ageing/afab039)
Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg. 2006;10(6):813–22. (PMID: 1676953710.1016/j.gassur.2005.12.010)
Riediger H, Krueger CM, Makowiec F, Adam U. Impact of age and comorbidity on perioperative mortality after 250 pancreatic head resections. Zentralbl Chir. 2016;141(3):270–6. (PMID: 2701133810.1055/s-0041-111520)
Lee DY, Schwartz JA, Wexelman B, Kirchoff D, Yang KC, Attiyeh F. Outcomes of pancreticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons national surgical Quality improvement program analysis. Am J Surg. 2014;207(4):540–8. (PMID: 2456058510.1016/j.amjsurg.2013.07.042)
Makary MA, Winter JM, Cameron JL, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10(3):347–56. (PMID: 1650487910.1016/j.gassur.2005.12.014)
Min Park H, Park SJ, Han SS, Hoon Kim S. Surgery for elderly patients with resectable pancreatic cancer, a comparison with non-surgical treatments: a retrospective study outcomes of resectable pancreatic cancer. BMC Cancer. 2019;19(1):1090. (PMID: 10.1186/s12885-019-6255-3)
Feilhauer K, Hennig R, Lenz S, Köninger J. Pancreatic resection in the elderly: is the risk justified? Chirurg. 2015;86(7):670–5. (PMID: 2523450410.1007/s00104-014-2869-9)
Oliveira-Cunha M, Malde DJ, Aldouri A, Morris-Stiff G, Menon KV, Malvern Smith A. Results of pancreatic surgery in the elderly: is age a barrier? HPB. 2013;15(1):24–30. (PMID: 2321677610.1111/j.1477-2574.2012.00549.x)
Bathe OF, Caldera LH, Francheschi D, et al. Radical resection in periampullary tumors in the elderly: evaluation of long-term results. World J Surg. 2000;24(3):353–8. (PMID: 1065807210.1007/s002689910056)
Van Rijssen LB, Groot Koerkamp B, Zwart MJ, et al. Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the dutch pancreatic cancer audit. HPB. 2017;19(10):919–26. (PMID: 2875436710.1016/j.hpb.2017.06.010)
van der Geest LG, van Rijssen LB, Molenaar IQ, et al. Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB. 2016;18(4):317–24. (PMID: 27037200481461510.1016/j.hpb.2016.01.515)
Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;246(15):1128–37. (PMID: 10.1056/NEJMsa012337)
De Wilde RF, Besselink MGH, van der Tweel I, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99(3):404–10. (PMID: 2223773110.1002/bjs.8664)
Augustin T, Burstein MD, Schneider EB, et al. Frailty predicts risk of life-threatening complications and mortality after pancreatic resections. Surgery. 2016;160(4):987–96. (PMID: 2754599210.1016/j.surg.2016.07.010)
Berkel AEM, Bongers BC, Kotte H, et al. Effects of Community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial. Ann Surg. 2022;275(2):e299–306. (PMID: 3344390510.1097/SLA.0000000000004702)
Dutch Pancreatic Cancer Audit (DPCA). 2021. Available at: http://www.dica.nl/dpca . Accessed 1 Oct 2020.
van Rijssen LB, Koerkamp BG, Zwart MJ, Bonsing BA, Bosscha K, van Dam RM, Wolfgang CL. Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the dutch pancreatic cancer audit. Hpb. 2017;19(10):919–26. (PMID: 2875436710.1016/j.hpb.2017.06.010)
Von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. (PMID: 10.1016/j.ijsu.2014.07.013)
Walker G, Charlson Comorbidity Index (CCI) Calculator. MdCALC. 2005. Available at: https://www.mdcalc.com/charlson-comorbidity-index-cci . Accessed 13 Nov 2020.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. American Joint Committee on Cancer Staging Manual (7th ed). New York, NY: Springer; 2010.
Federatie Medische Specialisten. Richtlijn Pancreascarcinoom. 2019. Available at: https://richtlijnendatabase.nl/richtlijn/pancreascarcinoom/startpagina.html . Accessed 1 Mar 2021.
Kurnat-Thoma EL, Murray MT, Juneau P. Frailty and Determinants of Health Among Older Adults in the United States 2011–2016. J Aging Health. 2021; 8982643211040706.
WHO criteria. 2011. Available at: https://www.who.int/vmnis/indicators/haemoglobin.pdf . Accessed 14 Oct 2021.
Kidney Disease Improving Global Outcomes guidelines. 2012. Available at: https://kdigo.org/wp-content/uploads/2017/02/KDIGO&#95;2012&#95;CKD&#95;GL.pdf . Accessed 24 Oct 2021.
Wilhelm-Leen ER, Hall YN, et al. Frailty and chronic kidney disease: the third national health and nutrition evaluation survey. Am J Med. 2009;122(664–671):e662.
Kahlmeyer A, Fiebig C, Mueller M, et al. Geriatric assessments can predict functional outcome and mortality after urological tumor surgery. Urol Int. 2021:1-10.
Mogal H, Vermilion SA, Dodson R, et al. Modified Frailty Index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2017;24(6):1714–21. (PMID: 28058551706481610.1245/s10434-016-5715-0)
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. (PMID: 15273542136012310.1097/01.sla.0000133083.54934.ae)
Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59(10):1087–91. (PMID: 1698014910.1016/j.jclinepi.2006.01.014)
Smits CHM, van den Beld HK, Aartsen MJ, Schroots JJF. Aging in the Netherlands: state of the art and science. Gerontologist. 2014;54(3):335–43. (PMID: 2400026710.1093/geront/gnt096)
Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Uesaka K. Impact of patient age on the postoperative survival in pancreatic head cancer. Ann Surg Oncol. 2017;24(11):3220–8. (PMID: 2869539010.1245/s10434-017-5994-0)
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med. 2018;379(25):2395–406. (PMID: 3057549010.1056/NEJMoa1809775)
Go S, Lee S, Bae WK, et al. Modified FOLFIRINOX versus S-1 as second-line chemotherapy in gemcitabine-failed metastatic pancreatic cancer patients: a randomised controlled trial (MPACA-3). Eur J Cancer. 2021;157:21–30. (PMID: 3446478210.1016/j.ejca.2021.08.002)
Hall PS, Swinson D, Cairns DA, et al. Efficacy of reduced-intensity chemotherapy with oxaliplatin and capecitabine on quality of life and cancer control among older and frail patients with advanced gastroesophageal cancer: The GO2 phase 3 randomized clinical trial. JAMA Oncol. 2021;7(6):869–77. (PMID: 33983395812044010.1001/jamaoncol.2021.0848)
Klaiber U, Leonhardt CS, Strobel O, Tjaden C, Hackert T, Neoptolemos JP. Neoadjuvant and adjuvant chemotherapy in pancreatic cancer. Langenbecks Arch Surg. 2018;403(8):917–32. (PMID: 3039777910.1007/s00423-018-1724-8)
Lambert A, Schwarz L, Ducreux M, Conroy T. Neoadjuvant treatment strategies in resectable pancreatic cancer. Cancers. 2021;13(18):4724. (PMID: 34572951846908310.3390/cancers13184724)
Hamad A, Brown ZJ, Ejaz AM, Dillhoff M, Cloyd JM. Neoadjuvant therapy for pancreatic ductal adenocarcinoma: opportunities for personalizes cancer care. World J Gastroenterol. 2021;27(27):4383–94. (PMID: 34366611831691010.3748/wjg.v27.i27.4383)
Shaw JF, Budiansky D, Shariff F, McIsaac D. The association of frailty with outcomes after cancer surgery: a systematic review and metaanalysis. Ann Surg Oncol Epub. 2022. https://doi.org/10.1245/s10434-021-11321-2 . (PMID: 10.1245/s10434-021-11321-2)
George EL, Hall DE, Youk A, et al. Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties. JAMA Surg. 2021;156(1):e205152. (PMID: 33206156)
Yamada S, Shimada M, Morine Y, Imura S, Ikemoto T, Saito Y, et al. Significance of frailty in prognosis after surgery in patients with pancreatic ductal adenocarcinoma. World J Surg Oncol. 2021;19:94. (PMID: 33781262800859010.1186/s12957-021-02205-6)
Guyton RL Jr, Mosquera C, Spaniolas K, Fitzgerald TL. Association of increasing frailty with detrimental outcomes after pancreatic resection. Am Surg. 2018;84(4):512–9. (PMID: 2971259810.1177/000313481808400423)
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. (PMID: 16129869118818510.1503/cmaj.050051)
Lin SH, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. (PMID: 27580947500785310.1186/s12877-016-0329-8)
Orimo H. Reviewing the definition of elderly. Nihon Ronen Igakkai Zasshi. 2006;43(1):27–34. (PMID: 1652179510.3143/geriatrics.43.27)
المشرفين على المادة: 0 (Pancreatic Hormones)
تواريخ الأحداث: Date Created: 20220602 Date Completed: 20220810 Latest Revision: 20231213
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC9356963
DOI: 10.1245/s10434-022-11831-7
PMID: 35653069
قاعدة البيانات: MEDLINE
الوصف
تدمد:1534-4681
DOI:10.1245/s10434-022-11831-7