Pancreatic cancer: Surgery is a feasible therapeutic option for elderly patients

<p>Abstract</p> <p>Background</p> <p>Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery.</p> <p>Methods</p> <p>The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70y).</p> <p>Results</p> <p>Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70y. Compared to patients < 70y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70y vs. < 70y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively.</p> <p>Conclusions</p> <p>Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients.</p

Total pancreatectomy: a national study

BACKGROUND: Total pancreatectomy (TP) is performed for various indications. Historically, morbidity and mortality have been high. Recent series reporting improved peri-operative mortality have renewed interest in TP. We performed a national review of TP including indication, patient/hospital characteristics, complications and peri-operative mortality. METHODS: The Nationwide Inpatient Sample (NIS) was queried to identify TPs performed during 1998 to 2006. Univariate analyses were used to compare patient/hospital characteristics. Multivariable logistic regression was performed to identify predictors of in-hospital mortality. Post-operative complications/disposition were assessed. RESULTS: From 1998 to 2006, 4013 weighted patient-discharges occurred for TP. Fifty-three per cent were male; mean age 58 years. Indication: neoplastic disease 67.8%. Post-operative complications occurred in 28%. Univariate analyses: TPs increased significantly (1998, n = 384 vs. 2006 n = 494, P \u3c 0.01). 77.1% of TPs occurred in teaching hospitals (P \u3c 0.0001), 86.4% in hospitals performing or = 70 Adjusted odds ratio (AOR) 3.4, 95% confidence interval (CI) 1.33-8.67], select patient comorbidities and year (referent = 2004-2006; 1998-2000 AOR 2.70; 95% CI 1.41-5.14) independently predicted in-patient mortality whereas hospital surgical volume did not. DISCUSSION: TP is increasingly performed nationwide with a concomitant decrease in peri-operative mortality. Patient characteristics, rather than hospital volume, predicted increased mortality

Competition components along productivity gradients – revisiting a classic dispute in ecology

Competition is ubiquitous in plant communities with various effects on plant fitness and community structure. A long-standing debate about different approaches to explain competition is the controversy between David Tilman and Philip Grime. Grime stated that the importance of competition relative to the impact of the environment increases along a productivity gradient, while Tilman argued that the intensity of competition is independent of productivity. To revisit this controversy, we assumed that the effects of plant–plant interactions are additive and applied the new competition indices by Díaz-Sierra et al. (2017) in a field experiment along a productivity gradient in S-Germany, using the rare arable plant Arnoseris minima as a study species. The ‘target technique' was applied, to separate the effects of root and shoot competition. The study plants were exposed to five competition treatments with three replicates in 18 sites, respectively. We investigated the expectation that root competition is more intense in unproductive sites than shoot competition. Additionally, we predicted survival to be less affected by competition than growth-related plant parameters. Using the biomass of individuals without competition as a proxy for site productivity there was a positive relationship with competition importance but no relationship with competition intensity when plants experienced full competition. Survival of the target plants was unaffected by competition. Root competition was the main mechanism determining the performance of the target plants, whereas the effect of shoot competition was relatively low albeit increasing with productivity. We conclude that when considering plant–plant interactions additive both Grime's and Tilman's theories can be supported.publishedVersio