Published online Feb 21, 2018. doi: 10.3748/wjg.v24.i7.844
Peer-review started: December 4, 2017
First decision: December 20, 2017
Revised: January 3, 2018
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: February 21, 2018
Pancreatic resection is the only treatment with curative potential for pancreatic cancer and periampullary cancer, and it is also a useful treatment for other benign diseases. But, compromised physiological reserve and comorbidities may counterindicate pancreatic resection on elderly patients. Over the last decade, several reports described outcomes for pancreatic resection on elderly patients; however the results are inconsistent. Some studies reported a positive association between age and the postoperative complications after pancreatic resections, whereas others found no association. Moreover, the majority of such studies were conducted in developed countries. For developing countries, the data was scarce.
The aging population worldwide is growing at a remarkable rate. It is predicted that the proportion of the population aged 65 or above, in developed and developing nations alike, will rise until at least 2050. The incidence of pancreatic and periampullary cancer is strongly age-related, and elderly patients represent 60% of all diagnosed cases. Pancreatic resection is the only treatment with curative potential for pancreatic and periampullary cancer, and it is also a useful treatment for other benign diseases. Thus, pancreatic surgeons will increasingly face decisions on whether to perform a pancreatic resection on elderly patients. As such, we conducted a single-center, large-scale retrospective study to examine the association between age and postoperative complications after pancreatic resections in Chinese patients.
The aim of this study is to examine the impact of aging on the short-term outcomes following pancreatic resection in elderly patients.
A retrospective cohort study using prospectively collected data was conducted at the Cancer Hospital of the Chinese Academy of Medical Sciences, China National Cancer Center. The patients were divided into those at the age of 65-years-old or above and those younger than 65 years. The patients aged at 65-years-old or above were defined as ‘elderly patients’. The following factors were compared between two groups: demographic characteristics, smoking and alcohol consumption, body mass index (BMI), hemoglobin and serum albumin levels, American Society of Anesthesiologists (ASA) score, preoperative biliary drainage, comorbidities (diabetes, coronary artery disease, hypertension, chronic obstructive pulmonary disease, hepatitis B), previous history of cancer, previous abdominal surgery, family history of cancer, surgical procedure, intraoperative data (operative time, intraoperative blood loss), pathologic data, postoperative hospital stay, cost, perioperative complications and perioperative mortality.
Compared to patients < 65-years-old, elderly patients had worse ASA scores (P = 0.007) and more comorbidities (62.6% vs 32.4%, P < 0.001). Operative time, intraoperative blood loss, postoperative hospital stay and cost were comparable. Elderly patients had more severe postoperative complications (grades IIIb-V) (16.8% vs 9.0%, P = 0.002) and higher postoperative mortality rates (5.5% vs 0.9%, P < 0.001). In the multivariate Cox proportional hazards model for severe postoperative complications (grades IIIb-V), age ≥ 65 years, BMI ≥ 24 kg/m2, pancreaticoduodenectomy and length of operation ≥ 241 min were significant.
Increasing age is an independent risk factor for severe postoperative complications (grades IIIb-V) after pancreatic resection. Therefore, pancreatic surgery should be considered with caution in elderly patients. Our results may contribute to informed decision-making for elderly patients. Aging is an independent risk factor for severe postoperative complications after pancreatic resection. We found that aging is an independent risk factor for severe postoperative complications after pancreatic resection. Our results might contribute to more informed decision-making for elderly patients. We found that aging is an independent risk factor for severe postoperative complications (grades IIIb-V) after pancreatic resection. Our results might contribute to more informed decision-making for elderly patients.
The association between age and postoperative complications after pancreatic resections in Chinese patients is unknown. Our study used the Clavien-Dindo classification system to classify the complications associated with pancreatic resection, and we found that aging is an independent risk factor for severe postoperative complications (grades IIIb-V). Our study may provide a more realistic view of complications following pancreatic resection.
Elderly patients had more severe postoperative complications and higher postoperative mortality rates. Age ≥ 65 years is an independent risk factor for severe postoperative complications (grades IIIb-V) after pancreatic resection. Outcomes for pancreatic resection on elderly patients are inconsistent. This potential deleterious effect of age on severe complications needs improvement for surgical management of elderly patients undergoing pancreatic resection.
We found that aging is an independent risk factor for severe postoperative complications (grades IIIb-V) after pancreatic resection. Our results might contribute to more informed decision-making for elderly patients.