Perioperative efficacy of pancreatoduodenectomy in elderly patients

Objective To evaluate the perioperative safety and clinical efficacy of pancreatoduodenectomy (PD) in elderly patients. Methods Clinical data of 593 patients undergoing PD in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 1994 to December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the age, all patients were divided into the elderly group (age≥70 years,n=97, 59 males and 38 females) and non-elderly group (age<70 years, n=496, 300 males and 196 females). The perioperative parameters were compared between two groups using rank sum test. The rates were compared using Chi-square test or Fisher's exact test. Results In elderly group, the median length of operative time was 333 (187-620) min and the intraoperative blood loss was 400 (50-2 500) ml, and was respectively 340 (180-920) min, 400 (50-18 000) ml in non-elderly group, where no significant difference was observed (Z=-1.249, -0.046; P>0.05). The perioperative mortality, overall incidence of complications and reoperation rate in elderly group were 11.3%, 45.4% and 10.3% , and were 6.0%, 40.7% and 11.1% respectively in non-elderly group, where no significant difference was observed (χ2=3.530, 0.718, 0.051; P>0.05). The incidence of operation-related complications was 35.1% in elderly group, and was 37.9% in non-elderly group, where no significant difference was observed (χ2=0.282, P>0.05). The incidence of non-operation-related complications was 18.6% in elderly group, significantly higher than 9.1% in non-elderly group (χ2=7.686, P<0.05). Conclusions For elderly patients, PD is technically safe as non-elderly patients. However, the incidence of non-operation-related complications is higher in elderly patients comparatively. A more comprehensive and detailed physical assessment is necessary before operation for the elderly patients. Key words: Pancreaticoduodenectomy; Perioperative care; Aged; Complication