Hepatobiliary and pancreatic surgery in the elderly: Current status

Area of Science:

• Hepatology
• Gastroenterology
• Surgical Oncology

Background:

• Hepato-pancreatico-biliary (HPB) surgery encompasses complex procedures like major hepatic resection and pancreatic surgery.
• These surgeries carry significant risks, but centers of excellence with high patient volumes have improved outcomes and resection rates.
• An increasing elderly population with comorbidities necessitates evaluating the benefits of major HPB surgery in this demographic.

Purpose of the Study:

• To critically evaluate the safety and efficacy of major HPB surgery in elderly patients.
• To compare morbidity, mortality, and cost-effectiveness of HPB procedures in elderly versus younger patient cohorts.

Main Methods:

• Literature analysis of studies focusing on elderly patients undergoing major hepatic resection and pancreaticoduodenectomy.
• Comparison of outcomes (morbidity, mortality, cost) between elderly (70+ years) and younger patients.

Main Results:

• Pancreaticoduodenectomy can be safely performed in selected elderly patients (70+), with comparable morbidity and mortality rates to younger patients.
• Major hepatic resections for cancers like hepatocellular carcinoma (HCC), Klatskin tumor, and gallbladder carcinoma also show similar outcomes in elderly patients.
• Cost analysis studies indicate comparable financial data between elderly and younger patient groups for these procedures.

Conclusions:

• Selected elderly patients (70+) can safely undergo major HPB surgery, including pancreaticoduodenectomy and hepatic resection, with outcomes comparable to younger individuals.
• Further research is needed for the very elderly (80+), but careful patient selection remains paramount for successful surgical outcomes in the geriatric population.