Is age a risk factor for major pancreatic surgery? An analysis of 300 resections

The aim of this study was to analyze if age alone is a risk factor in major pancreatic surgery.

From September 1, 1985 to December 31, 1997, 806 patients underwent surgery for malignant and benign diseases of the pancreas in a prospective case control study performed at the Department of Surgery, Johannes Gutenberg University Hospital Mainz. In 228 patients (men: n = 139; women: n = 89; mean age: 61 years; range: 23-83 years) we performed partial (n = 178) or total (n = 50) pancreaticoduodenectomy, which was combined with portal vein resection in 16 cases. Left pancreatic resection was carried out in 72 patients (men: n = 40; women: n = 32; mean age: 65 years; range: 28-86 years).

Surgical complications after pancreaticoduodenectomy occurred in 22.1% of patients < or = 70 years and in 30.2% of patients > 70 years, however, less than half of them had severe complications ranging below 50%. General complications developed in 16.1% of patients < or = 70 years and in 27.9% of patients > 70 years (p < 0.001). The mortality rates 30 and 90 days after surgery were 3.2% (< or = 70 years) and 2.3% (> 70 years), and 6.0% (< 70 years) and 6.9% (> 70 years), respectively. Regression analysis showed the following factors to exert an independent influence on mortality: Pre-operative serum bilirubin, the diameter of the pancreatic duct, intra-operative blood loss and the occurrence of surgical and nonsurgical complications. Age did not exert an independent influence on the prognosis of either morbidity or mortality. However, general complications developed significantly more often in elderly patients. After left pancreatic resection surgical complications developed in 29.3% (< or = 70 years) and 21.4% (> 70 years) of patients, however the rate of severe complications was below 10%. General complications occurred in 10.3% (< or = 70 years) and 28.6% (> 70 years) (p < 0.001). Mortality rates 30 and 90 days after operation were 1.7% (< or = 70 years) and 14.2% (> 70 years), and 3.4% (< or = 70 years) and 14.2% (> 70 years) (p = n.s.), respectively. Regression analysis showed the intra-operative blood loss to exert an independent influence on post-operative morbidity and mortality. Age had no independent influence on either morbidity or mortality.

Results obtained by this study show that, although general complications develop significantly more often in elderly patients, age is not an independent risk factor for post-operative mortality after major pancreatic resection. Factors of importance in improving the outcome of this operation include the experience of the surgeon in selecting patients eligible to undergo the procedure, his operative skills in performing major pancreatic resections, as well as better anticipation and management of post-operative complications.