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Published on: September 28, 2019
Comparison of postoperative morbidity in elderly patients who underwent pancreatic resection
Atsushi Nanashima1, Takafumi Abo, Takashi Nonaka
1Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@nagasaki-u.ac.jp
Insights
Pancreatectomy outcomes in elderly patients are similar across age groups, but comorbidities and preoperative risk scores increase with age. Careful patient selection is crucial for safe pancreatic surgery in older individuals.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Geriatric Surgery
Background:
- Pancreatectomy indications in elderly patients with pancreatic disease are debated.
- This study analyzes clinicopathological features and early outcomes of pancreatectomy across different age groups.
Purpose of the Study:
- To compare clinicopathological characteristics and early outcomes of pancreatectomy in patients stratified by age.
- To identify factors influencing postoperative outcomes in elderly patients undergoing pancreatectomy.
Main Methods:
- 147 patients undergoing pancreatectomy were divided into four age groups (<50, 50-69, 70-79, >80 years).
- Clinicopathological data, physiological ability, and surgical stress (preoperative risk score [PRS], surgical stress score [SSS], comprehensive risk score [CRS]) were evaluated.
Main Results:
- Comorbidity and American Society of Anesthesiologists (ASA) scores significantly increased with age.
- Pancreatectomy extent and lymphadenectomy were similar across groups; tumor stage and postoperative complications did not differ significantly.
- PRS and CRS increased with age, but SSS did not. Systemic comorbidity, ASA score, and PRS were associated with complications in univariate analysis.
Conclusions:
- Age-related increases in comorbidity and PRS are noted in patients undergoing pancreatectomy.
- Careful preoperative assessment, including comorbidity, ASA score, and PRS, is essential for elderly patients undergoing pancreatic surgery.
Background/Aims:
Operative indications for pancreatectomy in elderly patients with pancreatic disease remain controversial. We examined clinicopathological characteristics and early outcomes in each generation of 147 patients who underwent pancreatectomy.
Methodology:
Patients were divided into four groups: Group 1 (n=15, 10%), young patients <50 years old; Group 2 (n=65; 44%), patients at 50- 69 years old; Group 3 (n=61, 42%), patients at 70-79 years old and Group 4 (n=6, 4%), elderly patients >80 years old. Clinicopathological and surgical parameters were examined, including estimation of physiological ability and surgical stress consisting of preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS).
Results:
Prevalence of co-morbidity and American Society of Anesthesiologists (ASA) score increased significantly with increasing patient age (p<0.05). Extent of pancreatectomy and lymphadenectomy did not differ between groups and surgical records were similar. Tumor stage, postoperative course and complications were similar between groups. PRS and CRS increased significantly with increasing patient age (p<0.05) but SSS did not. Univariate analysis identified presence of systemic comorbidity, ASA score =2 and PRS =0.32 as factors associated with postoperative complications, but no independent predictive parameters were identified on multivariate analysis.
Conclusions:
Careful management and adequate decisions regarding pancreatectomy upon identification of co-morbidity, ASA score and PRS are important in elderly patients with pancreatic disease before pancreatectomy.