Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review

Prashant, S; Thoens, Jonathan; Mauricio, Szuchmacher; James, S.; Peter, DeVito

doi:10.1111/j.1477-2574.2012.00506.x

Cited by 139 publications

(48 citation statements)

References 19 publications

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“…These considerations are accentuated, as the elderly population is steadily growing and age remains an established risk factor for postoperative complications and mortality. 27,28 …”

Section: Discussionmentioning

confidence: 99%

Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

et al. 2015

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Objective To analyze the natural history of small asymptomatic pancreatic neuroendocrine tumors (PanNET) and to present a matched comparison between groups who underwent either initial observation or resection. Management approach for small PanNET is uncertain. Methods Incidentally discovered, sporadic, small (<3 cm), stage I–II PanNET were analyzed retrospectively between 1993 and 2013. Diagnosis was determined either by pathology or imaging characteristics. Intention-to-treat analysis was applied. Results A total of 464 patients were reviewed. Observation was recommended for 104 patients (observation group), and these patients were matched to 77 patients in the resection group based on tumor size at initial imaging. The observation group was significantly older (median 63 vs. 59 years, p = 0.04) and tended towards shorter follow-up (44 vs. 57 months, p = 0.06). Within the observation group, 26 of the 104 patients (25 %) underwent subsequent tumor resection after a median observation interval of 30 months (range 7–135). At the time of last follow-up of the observation group, the median tumor size had not changed (1.2 cm, p = 0.7), and no patient had developed evidence of metastases. Within the resection group, low-grade (G1) pathology was recorded in 72 (95 %) tumors and 5 (6 %) developed a recurrence, which occurred after a median of 5.1 (range 2.9–8.1) years. No patient in either group died from disease. Death from other causes occurred in 11 of 181 (6 %) patients. Conclusions In this study, no patient who was initially observed developed metastases or died from disease after a median follow-up of 44 months. Observation for stable, small, incidentally discovered PanNET is reasonable in selected patients.

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“…These considerations are accentuated, as the elderly population is steadily growing and age remains an established risk factor for postoperative complications and mortality. 27,28 …”

Section: Discussionmentioning

confidence: 99%

Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

et al. 2015

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“…Age limits are being pushed for various other types of major operations, such as oesophageal and pancreatic surgery, partly because of an increasing health status of the elderly [34-36]. Similarly, an increasing number of elderly patients with good performance status can be considered for hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients

et al. 2018

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Background: This systematic review and meta-analysis evaluated the short- and long-term outcomes of liver resection for colorectal liver metastases (CRLM) in elderly patients. Methods: A PubMed, EMBASE, and Cochrane Library search was performed from January 1995 to April 2017, for studies comparing both short- and long-term outcomes in younger and elderly patients undergoing liver resection for CRLM. Results: Eleven studies comparing patients aged <70 years with patients aged >70 years and 4 studies comparing patients aged <75 years with patients aged >75 years were included. Postoperative morbidity was similar in patients aged >70 years (27 vs. 30%; p = 0.35) but higher in patients aged >75 years (21 vs. 32%; p = 0.001). Postoperative mortality was higher in both patients aged >70 years (2 vs. 4%; p = 0.01) and in patients aged >75 years (1 vs. 6%; p = 0.02). Mean 5-year overall survival was lower in patients aged >70 years (40 vs. 32%; p < 0.001) but equal in patients aged >75 years (42 vs. 32%; p = 0.06). Conclusion: Although postoperative morbidity and mortality were increased with higher age, liver resection for CRLM seems justified in selected elderly patients.

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“…Considerable discussion in published literature regarding outcomes in elderly is currently underway. The published data is inconsistent as a result of differences in age groups under comparison [11]. Some authors have reported acceptable morbidity and mortality rates after a pancreatoduodenectomy (PD) in octogenarians [8].…”

Section: Discussionmentioning

confidence: 99%

“…Some papers demonstrate that octogenarians might undergo surgery without a significant increase of morbidity rates related to comorbidities such as cardiac or pulmonary diseases [18]. Nevertheless, the potential for non-surgical complications as well as the increased risk of perioperative mortality, which was obvious in our series, should be assessed and taken into account [8,11]. These risks are commonly associated with polypharmacy, cardiac and pulmonary diseases, poor nutritional status requiring intensive perioperative support and monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

Urbonas¹,

Gulbinas

Smailytė

et al. 2015

Dig Surg

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Background: It is supposed that a prolonged lifetime will be associated with increased incidence of PDAC among the elderly. Some studies show a tendency toward decreased survival in the elderly patients following pancreatoduodenectomy for PDAC. The aim of this study was to evaluate factors, influencing survival following pancreatoduodenectomy for PDAC in different age groups. Methods: Data of 251 patients after pancreatoduodenectomy for PDAC between 1999 and 2012 were analyzed. The Kaplan-Meier method and log-rank test were used to calculate survival and to compare differences between groups. The Cox proportional hazard model was applied to indentify independent prognosticators. Results: The overall median survival was 14.9 months. Postoperative morbidity was 25.5% with a 5.1% mortality rate. No significant differences in the overall morbidity (22.4 vs. 29.6%) or mortality (2.8 vs. 8.3%) rates were observed between different patients' age groups (<70 years and >70 years). Multivariate analysis revealed R1 resection (HR 1.76) and poor tumor differentiation (G3-G4) (HR 1.48) were independent negative factors for survival in patients <70 years. Lymph-node metastases (N1) - HR 4.89 and perineural invasion - HR 2.73 were independent prognosticators in the elderly. Conclusions: Our study highlighted different factors influencing long-term survival after pancreatoduodenectomy: R1 resection and poor tumor differentiation (G3-G4) were independent negative factors for survival in patients <70 years, while perineural invasion and lymph-node metastases result in worse survival among the elderly.

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Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review

Cited by 139 publications

References 19 publications

Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

Systematic Review and Meta-Analysis of Liver Resection for Colorectal Metastases in Elderly Patients

Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age

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