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Technical Detail for Robot Assisted Pancreaticoduodenectomy
Published on: September 28, 2019
Laboratory frailty index in pancreaticoduodenectomy: short-term safety and long-term prognosis
Toshiya Abe1, Kohei Nakata2, Yusuke Watanabe2
1Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. abe.toshiya.011@m.kyushu-u.ac.jp.
Purpose:
The Laboratory Frailty Index (FI-lab), derived from routine preoperative laboratory parameters, offers a simple and objective alternative to conventional frailty assessment. However, its clinical relevance in elderly patients undergoing pancreaticoduodenectomy (PD), particularly those with pancreatic ductal adenocarcinoma (PDAC), remains unclear.
Methods:
We retrospectively analyzed 350 patients aged ≥ 65 years who underwent PD between 2012 and 2021. Frailty was defined as FI-lab ≥ 0.40. Short-term outcomes, including major postoperative complications (Clavien-Dindo grade ≥IIIa) and in-hospital mortality, were compared between frail and non-frail patients. The long-term outcomes (overall survival [OS] and disease-free survival [DFS]) were evaluated in 166 patients with PDAC.
Results:
Ninety-seven patients (27.7%) were classified as frail. Frail patients had a lower body mass index, greater intraoperative blood loss, and higher transfusion rates, whereas major complications and mortality rates were comparable between the groups. In patients with PDAC, frailty was associated with shorter OS (27.5 vs. 42.2 months; p = 0.043) and DFS (16.7 vs. 23.4 months; p = 0.046), although it was not an independent prognostic factor.
Conclusions:
FI-lab-defined frailty was not associated with perioperative morbidity or mortality after PD. In patients with PDAC, FI-lab may serve as a supplementary tool for preoperative risk stratification by reflecting their physiological vulnerability.