Feasibility of pancreaticoduodenectomy for octogenarian based on safety and postoperative nutritional recovery

Pancreaticoduodenectomy (PD) for very elderly patients was still controversial. We evaluated the feasibility of PD for octogenarian (patients older than 80 years) from safety and postoperative nutritional changes including body composition.

We included 141 consecutive patients who underwent PD: 24 patients aged ≥80 years were assigned to the octogenarian group, and the remaining 117 were assigned to the non-octogenarian group. Surgical outcomes and the change in postoperative nutritional status (body weight and serum albumin level during 12 months post-surgery) were compared. Among latest 24 patients, the change of body composition was also evaluated using bioelectrical impedance analysis.

Preoperatively, the octogenarian group had a significantly lower Katz index score for Activities of Daily Living (P = 0.038), higher incidence of comorbidities (P < 0.05), lower serum albumin levels (P = 0.033), and lower body weight (P = 0.017) than the non-octogenarian patients; however, the incidence of morbidity and mortality was the same in both groups. Overall survival rates were lower in the octogenarian group, even without significant difference. Multivariate analysis showed that the diagnosis of pancreatic cancer (P = 0.022), the serum albumin level (P = 0.018), and the UICC stage (P = 0.009) were useful to be an independent and significant predictor of overall survival. In assessment of postoperative nutritional status including body composition, the octogenarian group was not inferior compared to the non-octogenarian group.

In this study, PD for octogenarian was safe and feasible including nutritional aspects. Although careful patient selection and optimal perioperative care are necessary to consider whether PD is indicated for elderly patients, the advanced age alone should not be an exclusion criterion in considering of PD.