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Laparoscopic pancreatoduodenectomy does not completely mitigate increased perioperative risks in elderly patients.
- Source :
-
HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2015 Oct; Vol. 17 (10), pp. 909-18. Date of Electronic Publication: 2015 Aug 20. - Publication Year :
- 2015
-
Abstract
- Background: Elderly patients undergoing open pancreatoduodenectomy (OPD) are at increased risk for surgical morbidity and mortality. Whether totally laparoscopic pancreatoduodenectomy (TLPD) mitigates these risks has not been evaluated.<br />Methods: A retrospective review of outcomes in patients submitted to pancreatoduodenectomy during 2007-2014 was conducted (n = 860). Outcomes in elderly patients (aged ≥70 years) were compared with those in non-elderly patients with respect to risk-adjusted postoperative morbidity and mortality. Differences in outcomes between patients submitted to OPD and TLPD, respectively, were evaluated in the elderly subgroup.<br />Results: In elderly patients, the incidences of cardiac events (odds ratio [OR] 3.21, P < 0.001), respiratory events (OR 1.68, P = 0.04), delayed gastric emptying (DGE) (OR 1.73, P = 0.003), increased length of stay (LoS, 1 additional day) (P < 0.001), discharge disposition other than home (OR 8.14, P < 0.001) and blood transfusion (OR 1.48, P = 0.05) were greater than in non-elderly patients. Morbidity and mortality did not differ between the OPD and TLPD subgroups of elderly patients. In elderly patients, OPD was associated with increased DGE (OR 1.80, P = 0.03), LoS (1 additional day; P < 0.001) and blood transfusion (OR 2.89, P < 0.001) compared with TLPD.<br />Conclusions: Elderly patients undergoing TLPD experience rates of mortality, morbidity and cardiorespiratory events similar to those in patients submitted to OPD. In elderly patients, TLPD offers benefits by decreasing DGE, LoS and blood transfusion requirements.<br /> (© 2015 International Hepato-Pancreato-Biliary Association.)
- Subjects :
- Age Factors
Aged
Female
Follow-Up Studies
Humans
Laparoscopy adverse effects
Length of Stay trends
Male
Middle Aged
Minnesota epidemiology
Morbidity trends
Pancreaticoduodenectomy adverse effects
Retrospective Studies
Risk Factors
Survival Rate trends
Treatment Outcome
Laparoscopy methods
Pancreaticoduodenectomy methods
Postoperative Complications epidemiology
Risk Assessment
Subjects
Details
- Language :
- English
- ISSN :
- 1477-2574
- Volume :
- 17
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- HPB : the official journal of the International Hepato Pancreato Biliary Association
- Publication Type :
- Academic Journal
- Accession number :
- 26294338
- Full Text :
- https://doi.org/10.1111/hpb.12456