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The Whipple Procedure in Elderly Patients with Pancreatic Cancer

One of the interesting aspects of the cutting edge of medicine and science as observed over the years is the pendulum swing as new discoveries are made and conclusions rendered, only later to become modified and placed in better context by further research.

A case in point is the increasing trend of research results that sanction the surgical treatment of older patients with pancreatic cancer (ductal adenocarcinoma of the pancreas). There are a number of studies in more recent times that indicate that the Whipple procedure (pancreaticoduodenectomy) can be used to good effect even for patients in their eighties. This is welcome news, as adenocarcinoma of the pancreas tends to be a disease of older patients.

Now comes a more cautionary study by Kosuge and colleagues from the National Cancer Center Hospital in Tokyo, as published this April in Langenbeck’s Archives of Surgery. These researchers compared the surgical and mortality outcomes of 22 patients older than 80 years of age with pancreatic cancer against those of a younger group.

They found that serious post-operative complication occurred in six of the elderly patients with this pancreatic cancer surgery, including an additional peri-operative death of one of the elderly patients. These results were significantly worse than those of the younger group. Also, importantly the median survival of the older patients was only 13 months, compared with 82 months for the younger group.

The researchers suggest caution in the selection for pancreatic cancer surgery of patients who are older than 80 years of age.

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Dale O’Brien, MD