• Roshan Ghimire Department of Surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Dhiresh Maharjan Department of Surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
  • Prabin Bikram Thapa Department of Surgery, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
Keywords: pancreaticoduodenectomy, septuagenarians, octogenarians, early outcome


Elderly population is growing because of increasing life expectancy. Decision-making for major surgery like pancreaticoduodenectomy in this group is challenging. Therefore, we evaluated the feasibility of this procedure by comparing perioperative outcomes in Septuagenarians and Octogenarians patients. From August 2017 to December 2019, 18 consecutive patients who underwent pancreaticoduodenectomy were enrolled. These patients were divided into two groups (group1 – septuagenarians and group 2 – octogenarians). A comparative study between two groups was done regarding perioperative outcome and early complications. 18 patients were enrolled, 10 patients (55.6%) were septuagenarians (70-80 years) and 8 (44.4%) patients were Octogenarians (>80 years). There was no significant difference in the rate of surgical and medical complications between the two groups. Furthermore, there were no significant differences in risk factors, blood loss and operating time between the groups. Overall mortality in the study is 5.5%. Pancreaticoduodenectomy is feasible treatment option in septuagenarians and octogenarians with the help of multidisciplinary approach. Age alone should not be considered as decision maker for pancreaticoduodenectomy.


[1] United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241.
[2] Nepal-Census-2011-Vol1.pdf.
[3] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68:394–424.
[4] Prashant S, Jonathan T, Mauricio S, James S, Peter D. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB. 2012; 14:649–57.
[5] Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2006; 10:347–56.
[6] Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB. 2011; 13:377–84.
[7] Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006; 244:10–15.
[8] Pratt WB, Gangavati A, Agarwal K, Schreiber R, Lipsitz LA, Callery MP, et al. Establishing standards of quality for elderly patients undergoing pancreatic resection. Arch Surg Chic Ill 1960. 2009; 144:950–56.
[9] Hardacre JM, Simo K, McGee MF, Stellato TA, Schulak JA. Pancreatic resection in octogenarians. J Surg Res. 2009; 156:129–32.
[10] Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, et al. Pancreatic resection in the elderly1 1No competing interests declared. J Am Coll Surg. 2004; 198:697–706.
[11] Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Nishioka R, et al. A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg. 2009; 16:675–80.
[12] Lee DY, Schwartz JA, Wexelman B, Kirchoff D, Yang KC, Attiyeh F. Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg. 2014; 207:540–48.
[13] Khan S, Sclabas G, Lombardo KR, Sarr MG, Nagorney D, Kendrick ML, et al. Pancreatoduodenectomy for Ductal Adenocarcinoma in the Very Elderly; Is It Safe and Justified? J Gastrointest Surg. 2010; 14:1826–31.
[14] Ghimire R, Bohora TP, Rupakheti S, Joshi MR, Sharma SK. Solid pseudopapillary neoplasm of the pancreas. Journal of Kathmandu Medical College, Vol.2, No. 3, Issue 5; Jul-Sep 2013; 152-55
[15] Melis M, Marcon F, Masi A, Pinna A, Sarpel U, Miller G, et al. The safety of a pancreaticoduodenectomy in patients older than 80 years: risk vs. benefits. HPB. 2012;14: 583–88.
[16] 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; 248:459–67.
[17] Paiella S, De Pastena M, Pollini T, Zancan G, Ciprani D, De Marchi G, 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; 23:3077.
[18] Hatzaras I, Schmidt C, Klemanski D, Muscarella P, Melvin WS, Ellison EC, et al. Pancreatic resection in the octogenarian: a safe option for pancreatic malignancy. J Am Coll Surg. 2011; 212:373–77.
[19] Barbas AS, Turley RS, Ceppa EP, Reddy SK, Blazer DG, Clary BM, et al. Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer. J Am Geriatr Soc. 2012; 60:344–50.
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