Abstract
The entire spectrum of benign and malignant pancreatic neoplasms can be seen in the elderly. Adenocarcinoma of the pancreas is by far the most important of these conditions, reflecting the frequency and lethality of the disease and the complexity of treatment. The incidence of pancreatic cancer rose dramatically from the 1930s until the mid-1970s, nearly doubling during this time period. Since 1973, the incidence in the United States has remained stable at 8–9 per 100,000 population, with over 28,000 new cases diagnosed yearly1 Carcinoma of the pancreas is an extremely lethal disease with an overall estimated cure rate of less than 5%. Although it represents only 2–3% of all cancers, it results in more than 6% of cancer deaths. As the population ages, it can be expected that increasing numbers of elderly patients will be diagnosed and require treatment for pancreatic cancer.
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References
Steele GD Jr, Osteen RT, Winchester DP, et al. Clinical highlights from the National Cancer Data Base. CA Cancer J Clin 1994;44:71.
MacMahon B. Risk factors for cancer of the pancreas. Cancer 1982;50:2676–2680.
Gold EG, Golden SB. Epidemiology of and risk factors for pancreatic cancer. Surg Oncol Clin North Am 1998;7: 67–91.
Wilentz RE, Hruban RH. Pathology of cancer of the pancreas. Surg Oncol North Am 1998;7:43–65.
Doll R, Muir M, Waterhous J (eds). Cancer Incidence in Five Continents, vol 2. Geneva: Internationalia Contre le Cancer, 1970.
Lillemoe KD. Pancreatic disease in the elderly. Surg Clin North Am 1994;74:317–344.
Steinberg W. The clinical utility of the CA-19–9 tumor associated antigen. Am J Gastroenterol 1990;85:350–355.
Dooley WC, Cameron JL, Pitt HA, et al. Is preoperative angiography useful in patients with periampullary tumors? Ann Surg 1992;211:649–655.
Rösch T, Braig C, Gain T, et al. Stayging of pancreatic and ampullary carcinoma by endoscopic ultrasonography: comparison with conventional sonography, computed tomography, and angiography. Gastroenterology 1992;102:188–199.
Warshaw AL, Tepper JE, Shipley WU. Laparoscopy in the staging and planning for pancreatic cancer. Am J Surg 1986;151:76–80.
Warshaw AL, Gu ZY, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990;125:230–233.
Pitt HA, Gomes AS, Louis JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 1985;201:545–553.
Lyaidakis NJ, Van der Heyde MN, Lubler MJ. An evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma. Acta Chir Scand 1987;153:665.
Povoski SP, Karpen MS, Conlon KC, et al. Positive intraoperative bile cultures at the time of pancreaticoduodenectomy are associated with preoperative biliary drainage and subsequent development of postoperative infectious complications and mortality. Gastroenterology 1998;114: A537.
Crist DW, Sitzmann JV, Cameron JL. Improved hospital morbidity, mortality and survival after the Whipple procedure. Ann Surg 1987;206:358–365.
Trede M, Schwall G, Saeger H. Survival after pancreaticoduodenectomy. Ann Surg 1990;211:447–458.
Cameron JL, Pitt HA, Yeo CJ, et al. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 1993;217:430–438.
Castillo CF, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130:295.
Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990’s: pathology, complications, outcomes. Ann Surg 1997;226: 248–260.
Herter FP, Cooperman AM, Ahlborn TN, Antinori C. Surgical experience with pancreatic and periampullary cancer. Ann Surg 1982;195:274–281.
Lerut JP, Gianello PR, Otte JB, Kestens PJ. Pancreaticoduodenal resection: surgical experience and evaluation of risk factors in 103 patients. Ann Surg 1984;199:432–437.
Obertop H, Bruining HA, Schattenkerk ME, et al. Operative approach to cancer of the head of the pancreas and the periampullary region. Br J Surg 1982;69:573–576.
Delcore R, Thomas JH, Hermreck AS. Pancreaticoduodenectomy for malignant pancreatic and periampullary neoplasms in elderly patients. Am J Surg 1991;162:532–536.
Hannoun L, Christophe M, Ribeiro J, et al. A report of forty-four instances of pancreaticoduodenal resection in patients more than seventy years of age. Surg Gynecol Obstet 1993; 177:556–560.
Fong Y, Blumgart LH, Fortner JG, Brennan MF. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 1995;222:426–437.
Sohn TA, Yeo CJ, Cameron JL, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 1998;2:207–216.
Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg 1995;221: 43–49.
Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645.
Bronman PC, Harries-Jones EP, Tobias R, et al. Prospective controlled trial of transhepatic incurable carcinoma of the head of the pancreas. Lancet 1986;1:69–71.
Shepard HA, Royle G, Ross APR, et al. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 1988;75:1166–1168.
Andersen JR, Sorensen SM, Kruse A, et al. Randomized trial of endoscopic prosthesis versus operative bypass in malignant obstructive jaundice. Gut 1989;30:1132–1135.
Smith AC, Dowsett JF, Russell RCG, Hatfield ARW, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 1994;344:1655–1660.
Lillemoe KD, Sauter PK, Pitt HA, et al. Current status of surgical palliation of periampullary carcinoma. Surg Gynecol Obstet 1993;176:1–10.
Sarr MG, Cameron JL. Surgical management of unresectable carcinoma of the pancreas. Surgery 1982;91:123–133.
Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable pancreatic cancer? Ann Surg 1999;230:322–330.
Lillemoe KD, Cameron JL, Kaufman HS, et al. Chemical splanchnicectomy in patients with unresectable pancreatic cancer: a prospective randomized trial. Ann Surg 1993;217: 447–457.
Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastric emptying following pancreaticoduodenectomy. Ann Surg 1993;218:229–238.
Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreati-cojejunostomy after pancreaticoduodenectomy. Ann Surg 1995;222:580.
Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann Surg 1995;221:721–733.
Kaiser MH, Ellenberg SS. Pancreatic cancer: adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;97:28–35.
Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987;59:2006–2101.
Talamini MA, Pitt HA, Hruban RH, et al. Spectrum of cystic tumors of the pancreas. Am J Surg 1992;10:117–124.
Warshaw AL, Comptom CC, Lewandrowski K, et al. Cystic tumors of the pancreas: new clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990;212:432–445.
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Lillemoe, K.D. (2001). Pancreatic Tumors: Pathophysiology and Treatment. In: Rosenthal, R.A., Zenilman, M.E., Katlic, M.R. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3432-4_53
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DOI: https://doi.org/10.1007/978-1-4757-3432-4_53
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