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

Abstract

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.

Short- and Long-Term Outcomes of Neoadjuvant Chemoradiotherapy Followed by Pancreatoduodenectomy in Elderly Patients with Resectable and Borderline Resectable Pancreatic Cancer: A Retrospective Study

“…Utsumi et al [ 7 ] evaluated long-term changes in nutritional status over one year after PD, which revealed that elderly patients had significantly lower albumin levels than their non-elderly counterparts, suggesting that elderly patients might face a prolonged recovery period and be at risk of malnutrition. Conversely, this study did not reveal differences in nutritional indicators, including albumin and PNI values, between the elderly and non-elderly groups over a two-year postoperative follow-up period.…”

“…With advancements in surgical techniques and perioperative care, PD is increasingly recognized as safe and effective for pancreatic ductal adenocarcinoma (PDAC), even among the elderly [ 2 , 3 , 4 , 5 , 6 ]. However, PD, a highly invasive pancreatic resection technique, has prompted numerous discussions concerning its suitability and significance for elderly patients with pancreatic cancer [ 4 , 5 , 6 , 7 , 8 , 9 ].…”