[Pancreaticoduodenectomy in elderly patients--a safe operation?]. / Duodenopancreatectomia cefalica la vârstnici--operatie sigura?

The aim of this study was to analyze the impact of age in mortality and morbidity after duodenopancreatectomy (DPC), setting the age of 70 as a cut-off. A retrospective study was made of two groups of patients (under 70 and over 70 years old) who underwent DPC in the Center of General Surgery and Hepatic Transplantation, Fundeni, Bucharest between 2001 and 2006 for malignant and benign tumors of the pancreatic head, distal biliary tract, duodenum, Vater's ampulla and chronic pancreatitis. 245 DPC were performed, 207 in patients under 70 years old (group A) and 38 in patients over 70 years old. Postoperative global morbidity rate was 58% in group B vs 49,9 % in group A. Postoperative mortality rate was 5,2% in group B and 4,8 % in group A. No significant differences were recorded in survival when comparing the two groups, both in pancreatic head cancer or distal biliary tract cancer. Under these circumstances, increased age is not determining an increase in postoperative mortality after DPC, but is associated with a higher risk of postoperative medical complications.

[Central pancreatectomy--indications, technique, outcomes]. / Pancreatectomia centrala--indicatii, tehnica, rezultate.

Central pancreatectomy is a conservative resectional procedure indicated for benign and low malignant tumors located in the neck and/or body of the pancreas. We report our experience on 5 patients and some considerations about this surgical technique from medical literature.

[The value of resection in pancreatic cancer: the analysis of an experience of 180 patients in 10 years]. / Valoarea rezectiei în cancerul pancreatic: analiza unei experiente de 180 de cazuri în 10 ani.

Pancreatic cancer (PC) represents one of the most severe malignant diseases, with an extremely high mortality rate (80% in the first year following diagnosis). The only potentially curative treatment is resection. This report evaluates the last 10-year experience in surgical resection for pancreatic cancer in the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest--Romania), between 01.01.1995-01.05.2004. From a total of 832 patients with pancreatic cancer who were surgically treated, 180 underwent various resections (a resecability rate of 21.6%). There were 120 resections for cancer of the pancreatic head: 61 Whipple procedures, 10 pilorus preserving pancreaticoduodenectomies, 10 pancreaticoduodenectomies associated with complex resection, 17 pancreaticoduodenectomies with resection of the portal vein, 15 pancreaticoduodenectomies with extensive lymphodissection, 2 subtotal pancreatectomies and 5 total pancreatectomies; 60 standard splenopancreatectomies were performed for cancer of the pancreatic tail. The overall morbidity was 34%--61 patients (38 with cancer of the pancreatic head and 23 with pancreatic cancer of the tail), with the prevalent complication represented by pancreatic fistula. The mortality rate was 6.6%--12 patients (9 with cancer of the pancreatic head and 3 with cancer of the tail); there was a continuous decreasing trend from 9.1% between 1994-1999 to 1.6% between 2002-2004. In our Center an increasing preoccupation for pancreatic surgery, along with an improved surgical experience, resulted in a constant raise in the number of patients resected for pancreatic cancer, with a low morbidity and mortality rate.