Role and outcomes of laparoscopic cholecystectomy in the elderly

Agrusa, Antonino; Romano, G.; Frazzetta, Giuseppe; Chianetta, Daniela; Sorce, Vincenzo; Buono, Giuseppe Di; Gulotta, Gaspare

doi:10.1016/j.ijsu.2014.08.385

Cited by 60 publications

(40 citation statements)

References 13 publications

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“…In this retrospective study the patient characteristics registered were age, gender, presenting symptoms, past medical history and presence of comorbidity with American Society of Anesthesiology (ASA) score, operative time, postoperative complication including causes of re-laparotomy and death [6,7]. We considered only resectable pancreatic cancer and periampullary neoplasms defined by absence of distant metastases, absence of local tumor extension to the celiac axis and hepatic artery as the lack of involvement of the superior mesenteric vasculature.…”

Section: Methodsmentioning

confidence: 99%

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Agrusa

Gallucci

Buono

et al. 2015

International Journal of Surgery

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a b s t r a c tIntroduction: Pancreatic cancer is the fourth cause of death from cancer in Western countries. The radical surgical resection is the only curative option for this pathology. The prevalence of this disease increases with age in population. The causes of pancreatic cancer are unknown, but we consider risk factors like smoke and tobacco usage, alcohol consumption coffee, history of diabetes or chronic pancreatitis. In this study we report our experience in the treatment of resectable pancreatic cancer and periampullary neoplasms with particular attention to evaluate the evolution of surgical technique and the clinical postoperative outcomes. Methods: In our Department between January 2010 and December 2014 we performed a total of 97 pancreaticoduodenectomy. We considered only resectable pancreatic cancer and periampullary neoplasms defined by absence of distant metastases, absence of local tumor extension to the celiac axis and hepatic artery as the lack of involvement of the superior mesenteric vasculature. None of these patients received neoadjuvant chemotherapy. Results: The mean age of these patients was 64.5 years. Jaundice was the commonest presenting symptom associated to anorexia and weight loss. The mean operative time was 295 min (±55 min). The mean blood loss was 450 ml and median blood transfusion was 1 units. 12.1% of patients had an intraabdominal complication. The commonest complication was Delayed Gastric Emptying responsable of increased length of hospital stay and readmission rate. Postoperative pancreatic fistula of grade C occurred in 4 patients. 2 patients developed a postpancreatectomy hemorrhage. Perioperative mortality was 4.1%. Conclusion: Pancreaticoduodenectomy is a complex surgical technique and the associated high morbidity and mortality resulted in initial reluctance to adopt this surgery for the management of pancreatic and periampullary tumors. Surgical outcomes of pancreatic surgery are better at high-volume experienced center reporting mortality rates below 5%. We perform an end-to-side duct-to-mucosa pancreaticojejunostomy with routinely use of internal pancreatic stent. However no one technique has been shown to definitely be the solution to the problem of postoperative pancreatic fistula. At our center we have a reasonable volume and our data are comparable to literature data.

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Section: Methodsmentioning

confidence: 99%

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Agrusa

Gallucci

Buono

et al. 2015

International Journal of Surgery

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“…A WHO meghatározása szerint 65 év felett "időseb-bekről", míg 80 éves kortól "legidősebbekről" beszélünk. Az időskorúak sebészi betegségeiről közölt cikkek nagy része 65-70 év feletti betegek adatait dolgozza fel, holott a társadalmak öregedésével a 80 évesnél idősebb populá-ció már jelentős betegcsoportot képvisel [4,5].…”

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A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

et al. 2016

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Bevezetés: Az epehólyag-kövesség előfordulási gyakorisága az életkorral nő, azonban a 80 év feletti betegek műtétjei-nek kimeneteléről alig vannak adatok. A társadalom elöregedésével a kérdés egyre időszerűbb. Célkitűzés: A 80 éves-nél idősebb betegeknél végzett akut és elektív cholecystectomiák elemzése. Módszer: A szerzők az elmúlt hat évben a 80 évesnél idősebb, cholelithiasis miatt operált betegeknél a műtét típusát, a konverzió arányát, a szövődmények gyakoriságát, a posztoperatív mortalitást, az intenzív osztályos és kórházi ápolási napok számát vizsgálták retrospektíven. Eredmények: A vizsgált időszakban a 69 elektív, 51 akut műtétet végeztek, utóbbiak 9,8%-ánál pancreatitist, 14%-ánál májtályogot, 27%-ánál choledocholithiasist találtak. Az elektív csoport 84%-ánál, míg az akut csoport 17,7%-ánál sikerült az epehólyag laparoszkópos eltávolítása. Az intenzív osztályos 9,1 vs. 1 nap, a teljes kórházi ápo-lás 12 vs. 3,6 nap volt az akut, illetve tervezett műtétnél. A sürgősséggel operált betegeknél a mortalitás 20% és a reoperáció 16% volt, elektív betegeknél egyik sem fordult elő. Következtetések: A laparoszkópos cholecystectomia idős betegek tervezett műtéteinél kiváló eredménnyel alkalmazható, ezért cholelithiasis esetén 80 év feletti betegeknél is törekedni kell az elektív műtétre. Orv. Hetil., 2016, 157(5), 185-190. Kulcsszavak: cholecystectomia, laparoszkópia, idős, morbiditás, mortalitásThe role of laparoscopy in cholecystectomy in patients with age of 80 or above Introduction: The incidence of cholelithiasis increases with age, however, there is still little data about the outcomes of cholecystectomy in patients with age of 80 and above. Population ageing presents tremenduous challenges for surgeons. Aim: The aim of the authors was to compare emergency and elective cholecystectomies performed in these elderly patients. Method: This retrospective study was based on the analysis of operation type, conversion rate, complications, mortality, length of hospital stay of all patients over 80 who underwent cholecystectomy in the last 6 years at the 1st Department of Surgery, Semmelweis University. Results: 69 elective and 51emergency operations were performed. In the emergency group pancreatitis was found in 9.8%, liver abscess in 14%, and common bile duct stones in 27% of the patients on admission. Laparoscopic cholecystectomy could be performed in 84% of patients in the elective group, while in 17.7% of patients in the emergency group. The length of stay at the intensive care unit was 9.1 and 1 days, while the total length of hospital stay was 12 and 3.6 days for the elective and emergency groups, respectively. In the emergency group mortality was 20% and reoperation was performed in 16% of patients, while at the elective group none of these occured. Conclusion: Laparoscopic cholecystectomy is safe as elective surgery for patients with age of 80 and above. For this reason the authors recommend elective cholecystectomy in this age group.

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“…CT showed also hypodense material consistent with mucine in the peritoneal cavity ( Figure 1). These reports encouraged us to carry out an exploratory diagnostic laparoscopy in emergency setting (3)(4)(5). After general anesthesia the patient was placed in dorsal lithotomy position (6, 7).…”

Section: Case Reportmentioning

confidence: 99%

Appendiceal mucinous neoplasms: an uncertain nosological entity. Report of a case

Agrusa¹,

Galia²,

Cucinella³

et al. 2016

Gchir

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Role and outcomes of laparoscopic cholecystectomy in the elderly

Cited by 60 publications

References 13 publications

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

Whipple’s pancreaticoduodenectomy: Surgical technique and perioperative clinical outcomes in a single center

A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

Appendiceal mucinous neoplasms: an uncertain nosological entity. Report of a case

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