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Short-term outcomes after minimally invasive versus open pancreaticoduodenectomy in elderly patients: a propensity
Shih-Min Yin1, Yueh-Wei Liu2, Yu-Yin Liu3
1Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, DAPI Rd. Niaosng Dist, Kaohsiung City, 83301, Taiwan. dreamhunteryin@hotmail.com.
Background:
To date, the evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy. This study aim to compare the risk and benefit between MIPD and open pancreatoduodenectomy (OPD) in elderly patients.
Methods:
From 2016 to 2020, we retrospective enrolled 26 patients underwent MIPD and other 119 patients underwent OPD. We firstly compared the baseline characteristics, 90-day mortality and short-term surgical outcomes of MIPD and OPD. Propensity score matching was applied for old age patient (≥ 65-year-old vs. < 65-year-old) for detail safety and feasibility analysis.
Results:
Patients received MIPD is significantly older, had poor performance status, less lymph node harvest, longer operation time, less postoperative hospital stay (POHS) and earlier drain removal. After 1:2 propensity score matching analysis, elderly patients in MIPD group had significantly poor performance status (P = 0.042) compared to OPD group. Patients receiving MIPD had significantly shorter POHS (18 vs. 25 days, P = 0.028), earlier drain removal (16 vs. 21 days, P = 0.012) and smaller delay gastric empty rate (5.9 vs. 32.4% P = 0.036). There was no 90-day mortality (0% vs. 11.8%, P = 0.186) and pulmonary complications (0% vs. 17.6%, P = 0.075) in MIPD group, and the major complication rate is comparable to OPD group (17.6% vs. 29.4%, P = 0.290).
Conclusion:
For elderly patients, MIPD is a feasible and safe option even in patients with inferior preoperative performance status. MIPD might also provide potential advantage for elderly patients in minimizing pulmonary complication and overall mortality over OPD.
Insights
Minimally invasive pancreatoduodenectomy (MIPD) is a safe and feasible option for elderly patients, showing reduced hospital stay and complications compared to open pancreatoduodenectomy (OPD). MIPD may lower mortality and pulmonary issues in this demographic.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Geriatric Medicine
Background:
- Evidence on minimally invasive pancreatoduodenectomy (MIPD) in elderly patients remains controversial.
- This study compares the safety and benefits of MIPD versus open pancreatoduodenectomy (OPD) in elderly patients.
Purpose of the Study:
- To evaluate the risks and benefits of MIPD compared to OPD in elderly patients.
- To assess the feasibility and safety of MIPD in older individuals, including those with poorer preoperative status.
Main Methods:
- Retrospective analysis of 26 MIPD and 119 OPD cases from 2016-2020.
- Propensity score matching was used to compare elderly (≥65 years) and younger (<65 years) patients.
- Outcomes included baseline characteristics, 90-day mortality, and short-term surgical results.
Main Results:
- MIPD patients were older with poorer performance status but had shorter postoperative hospital stays (18 vs. 25 days) and earlier drain removal (16 vs. 21 days).
- MIPD demonstrated a significantly lower delayed gastric emptying rate (5.9% vs. 32.4%).
- No 90-day mortality or pulmonary complications were observed in the MIPD group, with comparable major complication rates to OPD.
Conclusions:
- Minimally invasive pancreatoduodenectomy (MIPD) is a feasible and safe surgical option for elderly patients, even those with inferior preoperative performance status.
- MIPD offers potential advantages in reducing pulmonary complications and overall mortality compared to open pancreatoduodenectomy (OPD) in the elderly population.
