Pancreatic resections in elderly patients with high American Society of Anesthesiologists’ risk score: a view from a tertiary care center

Abstract

Background More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases. Aim To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk. Methods A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. Results Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients. Conclusions Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.

Laparoscopic distal pancreatectomy in patients with poor physical status

“…Age is not considered as an assessment measure in the ASA grading system, 8 and an older age can potentially increase the perioperative risk in patients with poor physical status. 22,23 In this study, roughly 50% of these patients were elderly. Similar to the results in the total cohort, elderly patients with ASA III-IV experienced a significantly higher incidence of medical complications compared to the elderly with ASA I-II.…”

Preoperative measures predicting outcome after pancreatic resection in aged patients

“…Selecting the most reasonable treatment for the aged is especially difficult among patients with suspected pancreatic cancer and potentially poor prognoses or with suspected premalignant pancreatic lesions with a potentially uncompromised life expectancy. Pancreatic resections are high-risk surgery, and in earlier studies, [1][2][3][4] preoperative frailty, age, chronic kidney disease, high American Society of Anesthesiologists (ASA) class, and sarcopenia have been associated with postoperative morbidity. However, it has been reported that neither short-term 5,6 nor long-term prognoses among the aged necessarily differ from those of unselected, younger patient cohorts.…”