An analysis of records of pancreatic surgery during the last 35 years at Johns Hopkins University in Baltimore by pancreatic cancer surgeon Charles J. Yeo, M.D., Samuel D. Gross Professor and chair of surgery at Jefferson Medical College of Thomas Jefferson University and Thomas Jefferson University Hospital in Philadelphia and Jefferson's Kimmel Cancer Center, and his colleagues have revealed that contrary to what many both in and out of medicine may believe, major pancreatic cancer surgery can successfully be performed on patients in their 80s, 90s and even older.
In the study, reported recently in the Journal of Gastrointestinal Surgery, Dr. Yeo and co-workers examined records of nearly 2,700 cases of the standard Whipple operation for pancreatic disease, including cancer. Of these, about 1,000 operations were performed in the last four years. The Whipple procedure entails the surgical removal of the head of the pancreas, the duodenum (part of the small intestine), part of the common bile duct, the gallbladder and sometimes a portion of the stomach.
AdvertisementOf this group, 207 patients were 80 years old or older. Those who were 80 to 89 years of age had a mortality rate of 4.1 percent (8 of 197), and a complication rate of 52.8 percent. Those younger than 80 years old had a mortality rate of 1.7 percent, with a complication rate of 41.6 percent. Of 10 patients 90 or older, the researchers reported no deaths after surgery, though half had complications. Of those 80 to 89 years old, 59.1 percent lived for at least one year, while 60 percent of patients 90 years and older lived that long after surgery.
Such complication rates for individuals at least 80 years old are what would be expected, Dr. Yeo says, and involve conditions that afflict many that age, such as heart disease, diabetes and high blood pressure. "The general aging population isn't dying from pancreas disease," he notes. "They are dying from other causes."
"If there is a mass that is resectable in the pancreas, chances are that we can take it out safely and the patient will do well," Dr. Yeo says. "As the population ages, more individuals may be eligible for such surgery."
The five-year survival of those who were operated on for cancer is comparable to the general population, he says. "In the general population, five-year survival in healthy individuals at age 80 is 69 percent. In our study, it was 55 percent, which isn't that much different."
For various reasons, many of those older than 80 have been told they are not candidates for pancreatic cancer surgery. "Whether it was because of other health issues, poor scans or just a mindset that operating on the pancreas after age 80 doesn't make much sense, there have been reasons not to operate on these individuals.
"The take home message is, if an experienced group of surgeons safely perform the right operation, the patient likely will do fine," Dr. Yeo says. "Patients usually can leave the hospital in a week and can be on a survival curve that approaches the normal curve of the general population."
According to Dr. Yeo, new imaging techniques, improved early detection and screening of high-risk groups, and new therapies on the horizon have begun to change the way pancreatic cancer is viewed. "We're actually making great progress when it comes to pancreatic cancer," he says.
Pancreatic cancer, the fifth-leading cause of cancer death in this country, takes some 30,000 lives a year. The disease is difficult to treat, particularly because it is frequently detected after it has spread to other areas on the body. Only 4 percent of all individuals with pancreatic cancer live for five years after diagnosis, and approximately 25 percent of those diagnosed with pancreatic cancer who undergo successful surgical removal of their disease live at least that long. But recent figures give new hope: of those who live for five years after surgical resection, some 55 percent will be alive at least another five years.