Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

Abstract

Background: Older patients are increasingly faced with pancreatic surgery because of shifting demographics. The differential effects of aging on surgical outcomes remain vague, while the elderly patient is often neglected in clinical trials. Methods: Medical records of 370 patients who underwent pancreaticoduodenectomy were analyzed. Patients were then subdivided into 3 groups according to age and comorbidities. Results: Overall mortality was 5% and did not significantly differ between age-matched groups. Increasing age was linked to a higher prevalence of diabetes mellitus (p < 0.001) and preoperative cardiovascular comorbidities (p < 0.001). Independent risk factors for major complications were age over 70 years (p = 0.018; OR 2.3), elevated body mass index (p = 0.004; OR 0.2) and cardiovascular comorbidities (p = 0.022; OR = 2.6). Patients who were older (>70 years), obese and had cardiovascular disease had an increased risk of major complications when compared with the younger study population (p = 0.010). Conclusions: Pancreatic surgery in elderly patients showed similar mortality rates as in younger patients. Nevertheless, a careful risk assessment is particularly important because older patients who are considered to be high risk suffer more frequently from major surgical complications compared with young patients that have similar risk profiles.

Surgical Outcomes Following Early Drain Removal After Distal Pancreatectomy in Elderly Patients

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A Review on Clinical Outcomes of Pancreaticoduodenectomy in Octogenarian Patients

“…39,43,44 However, longer operation times and higher incidences of organ injury. [45][46][47] are of particular concern when considering LPD surgery for elderly patients. 48 One retrospective analysis of robot-assisted PDs concluded that the procedure can be performed safely in elderly patients with mortality, morbidity, and outcomes comparable to those in younger patients.…”

The Benefit of Advanced Age on Survival in Patients Undergoing Laparoscopic Pancreaticodoudenectomy, A Multi-Center, Comparative study-Cohort Study

“…However, those selected for laparoscopic PD are predominantly otherwise healthy patients under the age of 75, with good performance status; thus, the extrapolation of results from such trials to daily practice necessitates careful consideration. Longer operation times and higher incidences of organ injury 9,10,11,12 , are of particular concern when considering LPD surgery for elderly patients 13 . One retrospective analysis of Robot-assisted PDs concluded that the procedure can be performed safely in elderly patients with mortality, morbidity, and outcomes comparable to those in younger patients 14 .…”