Evaluation of the Validity of Pancreatoduodenectomy for Elderly Patients With Ampullary Carcinoma from the Perspective of Nutritional Status at Recurrence

Background/Aim: Although, the number of pancreatoduodenectomy for elderly patients is increasing, the significance of pancreatoduodenectomy for long-term prognosis in elderly patients remains unclear. To clarify the validity of pancreatoduodenectomy in elderly patients with ampullary carcinoma, particularly in terms of nutritional status at recurrence.

Patients and Methods: We compared 21 patients aged ≥75 years and 40 patients aged <75 years, who underwent pancreatoduodenectomy for ampullary carcinoma and evaluated the relationship among age, nutritional status, and prognosis.

Results: The 5-year recurrence–free, disease-specific, and overall survival rates were similar ≥75 years: 42.9, 57.1, and 57.1%, respectively; and <75 years: 44.0, 69.9, and 62.1%; p=0.99, 0.41, and 0.48, respectively. The median time from recurrence to death was significantly shorter in elderly patients than in younger patients (1.3 vs. 1.8 years, p=0.0063). At recurrence, serum albumin levels, prognostic nutritional index, Glasgow prognostic score, controlling nutritional status score, and treatment rate were lower in elderly patients. Moreover, among elderly patients, these four nutritional indices were poorer in recurrent cases than in non-recurrent cases, whereas they were comparable in younger patients. Even in non-recurrent cases, these nutritional indices were similar between elderly and younger patients. In multivariate analysis, age ≥75 years was an independent risk factor for both a short time from recurrence to death and the likelihood of treatment implementation after recurrence (hazard ratio=3.3, odds ratio=0.019).

Conclusion: In elderly patients, some nutritional status and treatment rates at the time of recurrence were poorer, which resulted in shorter survival times after recurrence. Information on nutritional status changes based on age and recurrence may be important when considering treatment strategies for elderly patients.