Pancreaticoduodenectomy in elderly patients Hepatobiliary Pancreat Dis Int，Vol 15，No 4 • August 15，2016 • www.hbpdint.com • 419 Original Article / Pancreas Author Affiliations: Gastroenterology Surgical Center, Mansoura Univer- sity, Mansoura 35516, Egypt (El Nakeeb A, Atef E, El Hanafy E, Salem A, Askar W, Ezzat H, Shehta A and Abdel Wahab M) Corresponding Author: Ayman El Nakeeb, MD, Associate Professor of General Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura 35516, Egypt (Tel: +20-10-6752021; Email: elnakeebayman@ yahoo.com) © 2016, Hepatobiliary Pancreat Dis Int. All rights reserved. doi: 10.1016/S1499-3872(16)60105-4 Published online May 23, 2016. BACKGROUND: Although the mortality and morbidity of pancreaticoduodenectomy (PD) have improved significantly over the past years, the concerns for elderly patients undergo- ing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly pa- tients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients. METHODS: We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I (patients aged <60 years), group II (those aged 60 to 69 years) and group III (those aged ≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate. RESULTS: A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579 (69.9%) patients in group I, 201 (24.3%) in group II, and 48 (5.8%) in group III. The overall incidence of complications was higher in elderly patients (25.9% in group I, 36.8% in group II, and 37.5% in group III; P=0.006). There were more patients complicated with delayed gastric empty- ing in group II compared with the other two groups. There was no significant difference in the incidence of postoperative pancreatic fistula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality. CONCLUSIONS: PD can be performed safely in selected elderly patients. Advanced age alone should not be a contra- indication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of asso- ciated comorbidities. (Hepatobiliary Pancreat Dis Int 2016;15:419-427) KEY WORDS: pancreaticoduodenectomy; elderly; pancreatic fistula; delayed gastric emptying Introduction F ollowing the increase of life expectancy, the patients in general surgical department are getting older, about 60% of them are 65 years or older. [1] It is clear that the old age is one of the risk factors for the develop- ment of hepatobiliary and pancreatic tumors; the annual incidence of pancreatic tumors is 50 folds higher in the elderly than that in the young population, [2, 3] which leads to a dramatic increase in the number of elderly patients undergoing pancreaticoduodenectomy (PD). [3, 4] PD remains the main line of treatment of periampul- lary tumors. Although PD is a major and complex opera- tion which involves extensive resection and different re- construction procedures, the mortality rate has dropped to less than 5% in many published series whereas the rate of postoperative complications remains high from 40% to 50%. [5-7] Recently, many studies [1-4] expanded the selection criteria for PD to elderly patients. The signifi- cant improvement in the outcome of PD has encouraged surgeons to approach periampullary tumors as aggres- sively in elderly as in younger patients. The PD selection in elderly patients depends on their health status such as cardiopulmonary function and surgeon’s skills. Studies on the outcomes of PD for elderly patients are almost all from single high volume centers in the Outcomes of pancreaticoduodenectomy in elderly patients Ayman El Nakeeb, Ehab Atef, Ehab El Hanafy, Ali Salem, Waleed Askar, Helmy Ezzat, Ahmed Shehta and Mohamed Abdel Wahab Mansoura, Egypt