Impact of Patient Age on Morbidity and Survival Following Laparoscopic Pancreaticoduodenectomy

Meng, Linli; Xia, Qinghong; Cai, Yunqiang; Wang, Xin; Li, Yongbin; Cai, He; Peng, Bing

doi:10.1097/sle.0000000000000670

Cited by 15 publications

(38 citation statements)

References 25 publications

(32 reference statements)

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“…Among the remaining 451 articles, 414 were excluded following title and/or abstract screening according to the inclusion and exclusion criteria. Overall, after full-text review, 8 studies (8,(12)(13)(14)(15)(23)(24)(25) were included in the meta-analysis. The process of selecting relevant studies is presented in Figure 1.…”

Section: Search Results and Article Reviewmentioning

confidence: 99%

“…In total, 4 retrospective studies (14,15,23,24) from China were included in the analysis. 568 patients, who underwent LPD, were included in the analysis.…”

Section: Group 2: Lpd In Elderly and Non-elderly Patientsmentioning

confidence: 99%

“…Thus, despite LPD being performed more frequently in selected patients, the efficacy and safety of the procedure in elderly patients, who often suffer from pre-existing conditions (e.g., cardiovascular diseases) and poor functional reserve, remain unclear. Over the past few years, a number of studies (8,(12)(13)(14)(15) have focused on the outcomes of LPD in elderly patients. However, to the best of our knowledge, few systematic reviews and meta-analyses evaluating this inconsistent issue.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Wang

Chen

2022

Front. Surg.

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BackgroundThe safety and efficacy of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients who often suffer from pre-existing conditions (e.g., cardiovascular diseases) and poor functional reserve remain unclear. This meta-analysis aimed to evaluate the safety and efficacy of LPD in elderly patients.MethodsA systematic literature search was conducted using the PubMed, Embase, Web of Science, and Cochrane Library databases. All studies published from their inception to January 2022 reporting perioperative outcomes after LPD in elderly patients were included in the search (Group 1, comparing the perioperative outcomes of LPD and OPD in elderly patients; Group 2, comparing the perioperative outcomes after LPD between elderly and non-elderly patients). The evaluated outcomes included perioperative mortality, postoperative complications, conversion, operative time, estimated blood loss (EBL), postoperative hospital stay (POHS), and readmission.ResultsIn total 8 studies were included in the meta-analysis. Pooled analysis of Group 1 showed that EBL, 90-day mortality, major morbidity, bile leak, POH, abdominal infection, reoperation, POP, POCE, and readmission were not significantly different between the LPD and the OPD group. LPD was associated with longer operative time, lower POPF rate, lower DEG rate, and shorter POHS. Pooled analysis of Group 2 showed that mortality, major morbidity, POPF, DEG, bile leak, POH, abdominal infection, reoperation, conversion, operative time, EBL, and readmission were not significantly different between the elderly and the non-elderly group. The POHS of elderly group was significantly longer than non-elderly group.ConclusionLPD may be a safe and feasible procedure for elderly patients and is associated with short POHS.

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Section: Search Results and Article Reviewmentioning

confidence: 99%

“…In total, 4 retrospective studies (14,15,23,24) from China were included in the analysis. 568 patients, who underwent LPD, were included in the analysis.…”

Section: Group 2: Lpd In Elderly and Non-elderly Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Wang

Chen

2022

Front. Surg.

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“…However, in elderly patients who need to undergo pancreaticoduodenectomy, the mortality and morbidity rates were comparable between these two approaches, and LPD might have certain advantages over OPD (116). Similarly, several studies have also shown that LPD is safe and feasible in elderly patients (43,117,118). Topic 14: Follow-up after LPD Statement: Recurrence-free and overall survival after LPD are equal to that after OPD, and both procedures achieve equivalent rates of radical resection margins and number of harvested lymph nodes.…”

Section: Strength Of Recommendation: Strongmentioning

confidence: 99%

International expert consensus on laparoscopic pancreaticoduodenectomy*

Qin¹,

Kendrick²,

Wolfgang³

et al. 2020

Hepatobiliary Surg Nutr

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Importance: While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD.Objective: The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1 st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China.Findings: Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument. Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

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“…Most of the studies were underpowered. Long-term outcomes, such as overall survival and disease-free survival, were not systematically reported [27,28].…”

Section: Minimal Invasive Surgery In Pancreatic Cancermentioning

confidence: 99%

Pancreatoduodenectomy due to cancer in the older population

Kenig

Richter

2021

Nowotwory. Journal of Oncology

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By 2030, 70% of all pancreatic cancer will be diagnosed in the older population. However, pancreas operations are a complex surgical procedure with a high rate of morbidity and mortality. Therefore, the benefits of surgical resection in older patients are controversial and decisions about treatment for this group must be well balanced. Chronological age alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the comprehensive geriatric assessment (SGA), should be qualified for the same treatment as younger patients to benefit the same outcomes. However, they should be operated on in high-volume hospitals by experienced surgeons. Prefrail patients should undergo prehabilitation, during neoadjuvant treatment also, and then reevaluated. Frail patients should be discussed in an oncogeriatric meeting. We still do not have evidence-based data to design a tailored approach for them so as to balanced good oncologic outcomes and the appropriate postoperative quality of life.

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Impact of Patient Age on Morbidity and Survival Following Laparoscopic Pancreaticoduodenectomy

Cited by 15 publications

References 25 publications

Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

International expert consensus on laparoscopic pancreaticoduodenectomy*

Pancreatoduodenectomy due to cancer in the older population

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