Impact of age on short- and long-term outcome after pancreatoduodenectomy

Introduction: Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study aimes to analyze short- and long-term outcomes of PD in elderly patients. Methods: 124 consecutive patients, undergone PD for pancreas neoplasm in our center between 2012 and 2017, were analyzed. Patients were divided into two groups: group I (<70 years), group II (≥70 years). Demographic features, intraoperative and clinic-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to Clavien-Dindo score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results: 106 patients were included in this study. There were 64 (60.4%) patients in group I and 42 (39.6%) in group II. Perioperative deceases were 4 (3.6%), postoperative pancreatic fistulas were 34 (32,1%). Postoperative outcome data are summarized in table 1. Significant difference was demonstrated for ASA score (p < 0.01), pancreas consistency (p = 0.03), Karnofsky index (p < 0.01), preoperative jaundice (p = 0.03). 68,7% of patients in group I underwent adjuvant treatment vs 40,6% of older ones (p = 0,012). Mean overall survival was 26 months in group I vs 21,1 months in group II (p = 0,8). Conclusions: PD can be performed safely in elderly patients. Advanced age should not be a contraindication for PD. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.Tabled 1Postoperative outcome in 106 patientsParameterGroup I (64 pts < 70yrs)Group I (42 pts ≥ 70yrs)pOperative time, min309±96303±820.75Hospital Stay, days22±1021±120.57Reoperation, n°(%)4 (6,2)2 (4,8)0.87Postoperative Deceases, n°(%)1 (1,6)3 (7,1)0.14Pulmonary Complications, n°(%)0 (0)2 (4,7)0.08Cardiovascular complications, n°(%)3 (4,7)5 (11,9)0.26Other complications, n°(%)21 (32,8)10 (23,8)0.32Clavien-Dindo Score ≥ 3B, n°(%)6 (9,3)4 (9,5)0.98Pancreatic fistula (Grade B-C), n°(%)22 (34,4)12 (28,6)0.53 Open table in a new tab