Application of Laparoscopic Pancreatoduodenectomy in Elderly Patients

Pancreaticoduodenectomy (PD) involves complicated surgical procedures and is associated with high postoperative mortality. PD can be performed using laparoscopy; however, there is a lack of evidence on laparoscopic PD (LPD) outcomes in elderly patients. Therefore, this study aimed to compare LPD outcomes in elderly patients with those in patients aged <65 years and assess elderly outcomes according to the LPD surgical learning curve. In this retrospective study, medical records of 75 elderly patients (Group A) and 225 patients aged <65 years (Group B) were reviewed. Preoperative and postoperative data, as well as oncologic outcomes, were collected. To assess the effect of the surgical learning curve on outcomes of elderly patients, patients were equally divided into four phases, based on the number of surgeries performed at the study site. The mean preoperative physical status score was significantly higher in Group A than in Group B (z = 5.222, P < .001), indicating higher disease severity. There were no significant differences in operative time, intraoperative blood loss, vascular reconstruction rate, or intensive care unit (ICU) stay between the groups. The blood transfusion rate (χ² = 4.301, P = .038) and length of postoperative hospital stay (z = 2.386, P = .017) were significantly higher in Group A than in Group B. The surgical resection margins and the number of lymph nodes harvested did not differ between the two groups; however, a significant difference was observed in pathological results. In assessing the surgical learning curve, the pairwise comparison of means showed that the operation times in phases 3 and 4 were shorter than that in phase 1 (P < .05) and differences in nasogastric tube removal time between the four groups were statistically significant (H = 15.390, P = .002). Advanced age alone should not be a contraindication for LPD, since outcomes for elderly patients who have undergone LPD are similar to those for younger patients.