Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy

Kim, Sandy Y.; Fink, Michael A; Perini, Marcos Vinícius; Houli, Nezor; Weinberg, Laurence; Muralidharan, Vijayaragavan; Starkey, Graham; Jones, Robert; Christophi, Christopher; Nikfarjam, Mehrdad

doi:10.1111/ans.14039

Cited by 23 publications

(24 citation statements)

References 27 publications

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“…A systematic review showed that patients aged 80 years or older were 1.5 fold more likely to have a complication than their younger counterparts [23]. However, with regard to complications including POPF and operative factors, we found no differences between the groups, which is in line with ndings reported in other published studies [21,24,25]. Our experience shows that PD can be performed safely in elderly patients.…”

Section: Discussionsupporting

confidence: 91%

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Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

et al. 2020

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Background Con icting data on the safety of pancreaticoduodenectomy (PD) for elderly patients exist. Therefore, this study aimed to evaluate and compare the nutritional factors and clinical outcomes of PD between elderly and non-elderly patients. Methods A retrospective study of 122 consecutive patients who underwent PD from April 2008 to April 2020 was conducted. Preoperative and postoperative nutritional factors (prognostic nutritional index [PNI]), complication rates, and survival rates were compared between the elderly (age ≥80 years) and non-elderly (age <80 years) patient groups. Furthermore, changes in nutrition markers were evaluated before surgery to 1 year after surgery. Data were analyzed using unpaired Student's t-test, chi-squared test with Fisher's exact test, and log-rank test. Results A total of 20 elderly patients (16.4%) and 102 non-elderly patients (83.6%) underwent PD. With respect to preoperative factors, elderly patients had a signi cantly lower PNI than non-elderly patients. The duration of operation, amount of blood loss, postoperative complication rate, and incidence rate of pancreatic stula were similar between the two groups. At 3 months postoperatively, elderly patients had a lower albumin level and PNI than non-elderly patients. The median length of hospital stay was signi cantly longer in the elderly group than in the non-elderly group (39.9 vs. 27 days, P=0.004). The rate of death due to other diseases was relatively higher in the elderly group than in the non-elderly group. Elderly patients had a signi cantly lower overall survival rate than non-elderly patients (1-/3-/5-year overall survival rates: 78.1%/26.7%/13.3% vs. 87.1%/54.4%/46.7%; log-rank test, P=0.008). Conclusions Elderly patients had a lower nutritional status and lower survival rate than non-elderly patients. Careful patient selection and optimal perioperative care are necessary to determine whether PD is indicated for elderly patients.

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Section: Discussionsupporting

confidence: 91%

“…In several studies, the length of hospital stay was not different between the elderly and younger groups [24,27,28]. It should be noted that elderly patients were far more likely than younger patients to be discharged to a rehabilitation facility instead of home [29,30].…”

Section: Discussionmentioning

confidence: 95%

Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

et al. 2020

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“…It considered to the treatment for the periampullary cancer. Some reports revealed that PD was safe and feasible for the older patients in the aspect of short-term outcomes [23789]. However, there were some debates about whether PD had a survival benefit at long-term postoperative periods taking a high rate of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Short- and long-term outcomes of pancreaticoduodenectomy in elderly patients with periampullary cancer

Kang

Kim

et al. 2020

Ann Surg Treat Res

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PurposePancreaticoduodenectomy (PD) is recently performed in older cancer patients. The complication rate of PD is high. The present study was to compare the postoperative short- and long-term outcomes of PD in between older patients and younger patients.MethodsBetween 2000 and 2014, patients who underwent PD due to periampullary cancers were enrolled. Patients aged 75 years or over were included in the older group.ResultsTotal 1,249 patients were enrolled in this study and 168 patients (13.5%) were included in the older group. Postoperative complication rates, duration of postoperative hospital stay, and 30-day mortality were comparable between the 2 groups, although the admission rate of intensive care unit postoperatively was higher in the older adult group (20.8% vs. 10.5%, P < 0.001). In terms of long-term outcomes, 5-year overall survival rate was lower in the older group (23.4% vs. 41.8%, P < 0.001), and 5-year cumulative recurrence rate was higher in the older group without statistical significance (63.9% vs. 57.9%, P = 0.095). However, there were no statistical differences of cumulative recurrence in pancreatic cancer patients (81.5% vs. 82.5%, P = 0.805).ConclusionPD for periampullary cancer is a safe and feasible treatment in the older patients. The treatment modality for obtaining better survival outcomes will be investigated.

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“…The overall postoperative complication rate was high (OR 1.51, 95% CI 1.25-1.83, P < 0.001) in aged patients [70]. Another recent prospective study including 165 patients who had pancreaticoduodenectomy showed that the 90-day mortality rate (5.9% in those ≥ 80 years old vs. 2% in the younger group, P = 0.335) and the postoperative complication rate (64.7% in the elderly vs. 62.8% in the younger group, P = 0.83) were similar, although the older patients were far more likely to be discharged to a rehabilitation facility than younger patients were (47.1% vs. 12.8%, P < 0.001) [71]. Careful selection of elderly patients and optimal periopera-tive care, rather than age, should be used to determine whether surgical intervention is indicated.…”

Section: Anesthesia In Elderly Patientsmentioning

confidence: 86%

Anesthetic management of geriatric patients

Lim

2020

Korean J Anesthesiol

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The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.

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Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy

Cited by 23 publications

References 27 publications

Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

Short- and long-term outcomes of pancreaticoduodenectomy in elderly patients with periampullary cancer

Anesthetic management of geriatric patients

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