Aim
The number of surgeries for pancreatic ductal adenocarcinoma (PDAC) in older adults has been rising. This study aimed to evaluate the technical and oncological safety of pancreatectomy for older ...adults aged ≥75 years with PDAC by retrospectively comparing their short‐ and long‐term outcomes with those of younger adults aged <75 years.
Methods
Data were collected from 117 patients who underwent pancreatectomy for PDAC in our department. The indication for surgery regarding patient characteristics was considered according to each patient's American Society of Anesthesiologists physical status and Eastern Cooperative Oncology Group Performance Status Scale. Data of older adults (n = 32) were compared with those of younger adults (n = 85), and comprised patient background, surgical factors, postoperative course, histopathological factors and prognostic factors. Additionally, prognostic nutritional index values preoperatively and at 1 and 6 months postoperatively were compared between the two groups.
Results
Although American Society of Anesthesiologists physical status and comorbidities were worse in older adults, there were no significant differences in surgical factors, postoperative courses and histopathological factors between the two groups. The overall complication rate tended to be higher in older adults (40.6%) than in younger adults (29.4%). There were no differences in median lengths of recurrence‐free survival and overall survival (older adults vs younger adults: 12 vs 13 months, P = 0.545, and 26 vs 20 months, P = 0.535, respectively) between the two groups. Furthermore, no significant differences were found in prognostic nutritional index preoperatively to 6 months after surgery.
Conclusion
With careful determination of surgical indications, pancreatectomy for PDAC can be carried out with acceptable post‐pancreatectomy morbidity in younger adults. Geriatr Gerontol Int 2023; 23: 531–536.
This study aimed to evaluate the technical and oncological safety of pancreatectomy for older adults aged ≥75 years with pancreatic ductal adenocarcinoma by retrospectively comparing their short‐ and long‐term outcomes with those of younger adults aged <75 years. With careful determination of surgical indications, pancreatectomy for pancreatic ductal adenocarcinoma can be carried out with acceptable post‐pancreatectomy morbidity in older patients.
AimThe number of surgeries for pancreatic ductal adenocarcinoma (PDAC) in older adults has been rising. This study aimed to evaluate the technical and oncological safety of pancreatectomy for older ...adults aged ≥75 years with PDAC by retrospectively comparing their short‐ and long‐term outcomes with those of younger adults aged <75 years.MethodsData were collected from 117 patients who underwent pancreatectomy for PDAC in our department. The indication for surgery regarding patient characteristics was considered according to each patient's American Society of Anesthesiologists physical status and Eastern Cooperative Oncology Group Performance Status Scale. Data of older adults (n = 32) were compared with those of younger adults (n = 85), and comprised patient background, surgical factors, postoperative course, histopathological factors and prognostic factors. Additionally, prognostic nutritional index values preoperatively and at 1 and 6 months postoperatively were compared between the two groups.ResultsAlthough American Society of Anesthesiologists physical status and comorbidities were worse in older adults, there were no significant differences in surgical factors, postoperative courses and histopathological factors between the two groups. The overall complication rate tended to be higher in older adults (40.6%) than in younger adults (29.4%). There were no differences in median lengths of recurrence‐free survival and overall survival (older adults vs younger adults: 12 vs 13 months, P = 0.545, and 26 vs 20 months, P = 0.535, respectively) between the two groups. Furthermore, no significant differences were found in prognostic nutritional index preoperatively to 6 months after surgery.ConclusionWith careful determination of surgical indications, pancreatectomy for PDAC can be carried out with acceptable post‐pancreatectomy morbidity in younger adults. Geriatr Gerontol Int 2023; 23: 531–536.
A 76-year-old woman presented to our hospital complaining of acute-onset breathlessness and left-sided chest pain. Contrast-enhanced computed tomography revealed mediastinal emphysema, left pleural ...effusion, and partial rupture of the lower esophagus. She was referred to our department and diagnosed as having spontaneous esophageal rupture of the extra-mediastinal type. We performed emergency surgery, initially via a laparoscopic approach. As it was difficult to dissect the area around the esophageal hiatus due to severe inflammation, the procedure was converted to hand-assisted laparoscopic surgery (HALS), and the ruptured area on the left wall of the lower esophagus was sutured. Then, thoracoscopy-assisted drainage of the thoracic cavity and upper mediastinum was performed to drain the large amount of food residue in the thoracic cavity. The patient received postoperative intensive care due to sepsis, recovered well without pulmonary complications, and was transferred to a local hospital on the 34th postoperative day. Adoption of the minimally invasive abdominal and left thoracic approach (MALTA) can be effective for treating spontaneous esophageal rupture of the extra-mediastinal type in the elderly, and HALS may also be useful to avoid conversion to laparotomy and thoracotomy, and for enabling minimally invasive surgery even in the presence of severe local inflammation.
A 71-year-old man with epigastric pain was diagnosed with a pancreatic arteriovenous malformation (AVM) concomitant with acute pancreatitis and was brought to radiology for transcatheter arterial ...embolization (TAE). Computed tomography scan revealed abnormally dilated vessels in the pancreatic body and tail and a pseudocyst surrounding the tail of the pancreas. Angiography revealed an AVM across the entire pancreas, and TAE was contraindicated. Acute pancreatitis was treated non-operatively, and a pancreatic drain inserted due to stenosis of the main pancreatic duct. However, the patient remained refractory to this course of treatment for 6-months and was referred for surgical intervention. Distal pancreatectomy was performed, and the postoperative course was uneventful. No recurrence has occurred 4 years postoperatively. Surgery may be an effective therapeutic strategy for patients with pancreatic AVMs concomitant with acute pancreatitis.
To determine the efficacy of surgery for non-small cell lung cancer in patients who had previously undergone surgery for pancreaticobiliary cancer.
Seven patients who underwent pulmonary resection ...for primary lung cancer after curative surgery for pancreaticobiliary cancer at our Institution from 2006 to 2016 were retrospectively evaluated.
Five patients had metachronous and two patients had synchronous cancer of pancreaticobiliary and lung origin. The median time between surgeries for the two cancers was 35 months. All patients underwent complete resection of both cancers. The 5-year survival was 68.6% after pulmonary resection. Two patients had recurrence after lung surgery, with a mean recurrence-free interval of 6.5 months.
Surgery should be considered for lung cancer in patients who have undergone curative surgery for pancreaticobiliary cancer.
Some reports have shown that the prognosis of recurrent lung metastases after resection of pancreatic cancer is better than that for other organs. We report on 2 cases of long‒term survival after ...lung resection for lung metastases from pancreatic cancer. Case 1: A 73‒year‒old man underwent distal pancreatectomy for pancreatic body cancer. Adjuvant chemotherapy of S‒1 was administered for 6 months. At 3 years after surgery, 2 small metastatic nodules were detected in the right lung, and the patient underwent thoracoscopic right upper lobectomy. At 5 years and 9 months after the initial surgery, he is alive without recurrence. Case 2: An 81‒year‒old woman underwent pylorus‒preserving pancreatoduodenectomy for pancreatic head cancer. Adjuvant chemotherapy of S‒1 was administered for 4 months. At 1 year and 9 months after surgery, a metastatic nodule was detected in the left upper lung, and the patient underwent thoracoscopic left upper lobectomy. At 4 years and 6 months after initial surgery, radiation therapy was performed for localized bone metastasis. At 5 years and 1 month after the initial surgery, she is alive without other recurrences. In conclusion, recurrent lung metastases of pancreatic cancer with a small number of metastases may result in long‒term survival following resection.
A 48–year–old man was admitted to the emergency department of a local hospital because of acute abdominal pain and loss of consciousness. Abdominal enhanced computed tomography revealed a ruptured ...aneurysm of the middle colic artery (MCA) and he was referred to our hospital. An abdominal angiogram also revealed an aneurysm in the main trunk of the MCA. During angiography, we confirmed blood flow between the right branch of the MCA and the right colic artery and between the left branch of the MCA and the marginal artery of the descending colon. Therefore, we performed coil embolization for the aneurysm. The postoperative course was uneventful. Angiography is useful for the diagnosis of ruptured aneurysm, if the vital signs are stable. Post embolization resection of the colon can be avoided depending upon the location of the middle colic aneurysm.
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