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[Short-term results of pancreatoduodenectomy in patients over 70 years old]
G A Shatveryan1, N K Chardarov1, V V Nikoda1
1Petrovsky National Research Centre of Surgery, Moscow, Russia.
Insights
This study found that patients undergoing pancreaticoduodenectomy (PDE) aged 70 and older had comparable short-term outcomes to younger patients. Age is not a contraindication for PDE surgery when considering overall health.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Geriatric Medicine
Background:
- Pancreaticoduodenectomy (PDE) is a complex procedure with potential risks.
- Assessing surgical risk in elderly patients is crucial for optimizing outcomes.
Purpose of the Study:
- To compare the immediate postoperative results of pancreaticoduodenectomy (PDE) in patients younger than 70 years versus those 70 years and older.
Main Methods:
- Retrospective analysis of 110 PDE procedures performed between March 2010 and February 2019.
- Patients were divided into two groups: <70 years and ≥70 years.
- Primary endpoints included postoperative mortality and complication rates, with secondary analysis of specific complications and hospital stay.
Main Results:
- While elderly patients (≥70 years) had higher ASA and PMP scores, mortality rates were not significantly different (11.7% vs. 3.2%).
- Overall morbidity, major complications (grade ≥IIIa), delayed gastric emptying, pancreatic fistula, and biliary fistula rates were comparable between the two age groups.
- Postoperative hospital stay was also similar across both groups.
Conclusions:
- Short-term outcomes of pancreaticoduodenectomy (PDE) are comparable between patients younger than 70 and those 70 and older.
- Patient's general health status and comorbidities, rather than age alone, should guide surgical candidacy for PDE.
- Age should not be considered an absolute contraindication for pancreaticoduodenectomy.
Objective:
To analyze the immediate results of PDE in patients younger and older 70 years.
Material And Methods:
The study included patients who underwent PDE for various indications from March 2010 to February 2019. All patients are divided into 2 groups: <70 years old and ≥70 years old. Primary endpoints were postoperative mortality and complication rate.
Results:
There were 110 procedures within 9 years. There were 93 patients aged <70 years (group 1) and 17 patients aged ≥70 years (group 2). ASA (American Society of Anesthesiologists) and PMP scores (Preoperative Mortality Predictor) were higher in group 2: 3 (2-3) vs 2 (1-3) (p=0,002) and 12 (6-15) vs 6.5 (5-15) (p<0.001), respectively. Mortality rate was higher in group 2 (11.7% vs. 3.2%) without statistical significance (p=0.16). Overall morbidity (72% vs 76%; p=1.0), incidence of major complications grade ≥IIIa (29% vs 29%), delayed gastric emptying B/C (17.2% vs 17.6%), pancreatic fistula grade B/C (23.6% vs 35.3%, p=0.3), biliary fistula grade B/C (7.5% vs 11.8%; p=0.62), postoperative hospital-stay [22 (8-165) days vs 23 (9-71) days; p=0.92] were comparable in both groups.
Conclusion:
Short-term results of PDE in patients aged <70 and ≥70 years are comparable despite higher ASA and PMP scores in the group 2. General status and concomitant diseases should be considered during selection of patients with resectable tumors for PDE. Age per se is not a contraindication for surgery.
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