Oncogeriatric Assessment: A Key Step in the Preoperative Workup. Case Report of a Duodenopancreatectomy in an 80-Year-Old Patient

Hélène Levassort1, Frédérique-Sophie Peschaud2,3, Djamel Ghebriou4, Clotilde Picart1, Marion Pépin1,5 and Tristan Cudennec1*

1Department of Geriatrics, University of Paris-Saclay, Site Ambroise Paré, France
2Department of Digestive Surgery, Oncological and Metabolic, University of Paris-Saclay, Site Ambroise Paré France
3UVSQ, University of Paris-Saclay, UFR des Sciences de la Santé Simone Veil, France
4Department of Medical Oncology, IUC AP-HP, Sorbonne University, Hôpital Tenon, France
5Versailles Saint-Quentin-en-Yvelines University, University of Paris-Saclay, France

^*Correspondance to: Tristan Cudennec 

 PDF  Full Text DOI: 10.25107/2474-1647.3560

Abstract

Background: Pancreatic cancer is the 12th most common malignancy worldwide and the 7th leading cause of cancer mortality. Its incidence is increasing in older people, who are particularly characterized by high phenotypic variability in terms of comorbidity, dependence, nutritional and cognitive impairment, each of those being able to interact with the results of reference therapies. Aging is a heterogeneous process that cannot be understood simply by chronological age and must take into account all of these factors. The Comprehensive Geriatric Assessment (CGA) must therefore play an important role in therapeutic reflection to avoid over- or under-treatment in this population. This assessment identifies previously unknown geriatric syndromes in nearly 50% of cases, but also leads to specific interventions in a quarter of cases, and modifies the choice of oncological treatment in 20% to 25% of cases in order to find the best association between quality of life and quantity of life. This reflection on the best therapies and their implementation must be established with the patient himself from the beginning of the treatment. Case Report: Mrs. M is 80 years old, independent and in good condition. She presented with jaundice without fever, which led to discover an adenocarcinoma of the head of the pancreas by Magnetic Resonance Imaging (MRI), and echo-endoscopy, without any secondary lesions on imaging. Following the patient's wishes and the oncogeriatric opinion, it was decided to perform a cephalic duodenopancreatectomy. The patient recovered progressively and it was decided to start adjuvant chemotherapy for a pT3N1b stage. After a stay in follow-up care and rehabilitation allowing a resumption of her autonomy, a good nutritional status, and the setting up of a care network at home, the patient returned home. Conclusion: Despite its aggressive nature and an often more frailty phenotype of older people, treatment options in pancreatic cancer are not absent for this population. Just as the evaluation of the cancer itself requires TNM staging, the evaluation of the elderly cancer patient must include an oncogeriatric evaluation to provide the best management according to the patient's wishes and the treatment options available. This evaluation can lead to a pre-habilitation program to give the patient all chances to benefit from the best possible results.

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Cite the article

Levassort H, Peschaud F-S, Ghebriou D, Picart C, Pépin M, Cudennec T. Oncogeriatric Assessment: A Key Step in the Preoperative Workup. Case Report of a Duodenopancreatectomy in an 80-Year-Old Patient. Clin Surg. 2022; 7: 3560.