Pancreaticoduodenectomy in octogenarian patients with tumors in the head of the pancreas and periampular region

Abstract

Aging of the Spanish population has been demonstrated throughout the years. Thus, in the year 2021, the number of octogenarians in Spain was 2.285.352 people, confirming that Spain was the European country with the longest life expectancy (82.3 years in 2020). On the other hand, population aging has been associated with a higher incidence of tumors, including pancreatic cancer (PC) with a total number of 8,697 cases in Spain during 2021. It has been estimated that PC will soon surpass breast cancer in Europe to become the third most common cause of cancer-related death. Pancreaticoduodenectomy (PD) associated with chemotherapy is the standard therapy for potentially curing tumors of the pancreatic head and periampular region. However, PD is not a universally accepted therapy in octogenarian patients with pancreatic head tumors due to the presence of an associated high comorbidity and low expected survival with surgery. On the other hand, a significant decrease in postoperative mortality and increased survival (mortality rate between 25-27% and 5-year patient survival rate of 25% during the period 1975-1985 in the past century, versus <5% of postoperative mortality and 5-year survival of 15% in the present century), has encouraged highly experienced surgeons to perform increasingly a PD for pancreatic head cancer due to the good results reported. In this review we analyze the diagnostic procedures, indications for surgical therapy and chemotherapy, and results using PD technique in octogenarian patients suffering from tumors located in the head of the pancreas or periampular region.