Outcomes of pancreaticoduodenectomy in elderly patients

BACKGROUND: Although the mortality and morbidity of pancreaticoduodenectomy (PD) have improved signiifcantly over the past years, the concerns for elderly patients undergo-ing PD are still present. Furthermore, the frequency of PD is increasing because of the increasing proportion of elderly pa-tients and the increasing incidence of periampullary tumors. This study aimed to analyze the outcomes of PD in elderly patients.
METHODS: We studied all patients who had undergone PD in our center between January 1995 and February 2015. The patients were divided into three groups based on age: group I (patients aged <60 years), group II (those aged 60 to 69 years) and group III (those aged≥70 years). The primary outcome was the rate of total postoperative complications. Secondary endpoint included total operative time, hospital mortality, length of postoperative hospital stay, delayed gastric emptying, re-exploration, and survival rate.
RESULTS: A total of 828 patients who had undergone PD for resection of periampullary tumor were included in this study. There were 579 (69.9%) patients in group I, 201 (24.3%) in group II, and 48 (5.8%) in group III. The overall incidence of complications was higher in elderly patients (25.9% in group I, 36.8% in group II, and 37.5% in group III;P=0.006). There were more patients complicated with delayed gastric empty-ing in group II compared with the other two groups. There was no signiifcant difference in the incidence of postoperative pancreatic ifstula, biliary leakage, pancreatitis, pulmonary complications and hospital mortality.
CONCLUSIONS: PD can be performed safely in selected elderly patients. Advanced age alone should not be a contra-indication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, and the increased rate of complications is due to the presence of asso-ciated comorbidities.