Key result
Elderly age was not independently associated with postoperative morbidity, whereas preoperative hemoglobin (OR 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002) were significant predictors.
Why the study?
Is major hepatic or pancreatic surgery as safe in elderly patients (≥70 years) as in younger patients (<70 years)?
Cohort (n=1,012)
Is major hepatic or pancreatic surgery as safe in elderly patients (≥70 years) as in younger patients (<70 years)?
Hepatic resection and pancreaticoduodenectomy can be safely performed in selected elderly patients, with morbidity driven by factors like preoperative hemoglobin and intraoperative transfusion rather than age itself.
Selected elderly patients may undergo major HPB surgery without excess morbidity risk from age alone; leaves open prospective validation of hemoglobin and transfusion optimization.
Objective: The aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years). Methods: A total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis. Results: Elderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p <0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p =0.029 and p =0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p =0.007) and intraoperative blood transfusion (OR 1.9, p =0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p =0.001), preoperative hemoglobin (OR 1.6, p =0.036), and pancreatic versus hepatic surgery (OR 2.3, p =0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p =0.033) and intraoperative blood transfusion (OR 3.2, p =0.030) were independently associated with postoperative morbidity. Conclusion: HR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries.
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Lu et al. (2018) conducted a cohort in Cancer patients undergoing hepatic resection or pancreaticoduodenectomy (n=1,012). Elderly age (≥70 years) vs. Younger adults (<70 years) was evaluated on Incidence and severity of morbidity within 30 days postoperatively. Elderly age was not independently associated with postoperative morbidity, whereas preoperative hemoglobin (OR 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002) were significant predictors.
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