Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

Abstract

AIM:To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy. METHODS:Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years. RESULTS:The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P=0.3172). CONCLUSION:It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.Wu YL, Yu JX, Xu B. Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients. World

Nosocomial Infections and Microbiologic Spectrum after Major Elective Surgery of the Pancreas, Liver, Stomach, and Esophagus

“…Infection rates for patients with complex procedures are estimated between 2.9% and 13.0% [12]. These classifications are easy to apply but might not reflect the actual risk for post- [24] showed pancreatoduodenectomy and hepatectomy with resection of more than two segments being independent factors for major post-operative complications. Despite both being complex surgical procedures, the odds ratio (OR) differed notably (3.77, p = 0.0006 for pancreatoduodenectomy versus 1.08, p = 0.03 for hepatectomy).…”

Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile?

“…Many publications have suggested that major abdominal surgery due to cancer can be performed safely in elderly patients with good results and the preoperative selection must be based on physiologic criteria and performance status rather than on chronological aspects [2,15,16]. However, in the publication of Polanczyk et al [1], in which 4315 patients were included and stratified into 4 age groups, after adjusting for functional status and type of surgery, they concluded that elderly patients have an increased risk of postoperative complications.…”

Outcome of hepatectomy in super‐elderly patients with hepatocellular carcinoma

“…With the advancement of surgical techniques and perioperative management, hepatectomy has been regarded as the most effective and commonly used treatment for HCC. Although some studies have found significantly higher morbidity or mortality after hepatectomy for HCC in elderly patients, 2–7 comparable surgical outcomes with younger patients have also been reported 8–17 . There has been one report on the safety and feasibility of hepatectomy for HCC patients aged 80 years or more 17 .…”