Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2018; 24(7): 844-851
Published online Feb 21, 2018. doi: 10.3748/wjg.v24.i7.844
Elderly patients had more severe postoperative complications after pancreatic resection: A retrospective analysis of 727 patients
Ying-Tai Chen, Fu-Hai Ma, Cheng-Feng Wang, Dong-Bing Zhao, Ya-Wei Zhang, Yan-Tao Tian
Ying-Tai Chen, Fu-Hai Ma, Cheng-Feng Wang, Dong-Bing Zhao, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ya-Wei Zhang, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, United States
Author contributions: Tian YT contributed to study conception and design; Ma FH, Chen YT and Zhang YW contributed to data acquisition, analysis and interpretation, and writing of the article; Wang CF, Zhao DB and Tian YT performed the operations.
Supported by National Natural Science Foundation of China, No. 81401947; Beijing Nova Program, No. xxjh2015A090.
Institutional review board statement: The study was reviewed and approved by the Cancer Hospital of the Chinese Academy of Medical Sciences.
Informed consent statement: All study participants provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The original anonymized dataset is available upon request from the corresponding author at tyt67@163.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. tyt67@163.com
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: December 3, 2017
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
Processing time: 67 Days and 17.8 Hours
Abstract
AIM

To examine the impact of aging on the short-term outcomes following pancreatic resection (PR) in elderly patients.

METHODS

A retrospective cohort study using prospectively collected data was conducted at the China National Cancer Center. Consecutive patients who underwent PR from January 2004 to December 2015 were identified and included. ‘Elderly patient’ was defined as ones age 65 and above. Comorbidities, clinicopathology, perioperative variables, and postoperative morbidity and mortality were compared between the elderly and young patients. Univariate and multivariate analyses were performed using the Cox proportional hazard model for severe postoperative complications (grades IIIb-V).

RESULTS

A total of 454 (63.4%) patients were < 65-years-old and 273 (36.6%) patients were ≥ 65-years-old, respectively. Compared to patients < 65-years-old, elderly patients had worse American Society of Anesthesiologists scores (P = 0.007) and more comorbidities (62.6% vs 32.4%, P < 0.001). Elderly patients had more severe postoperative complications (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, age ≥ 65 years [hazard ratio (HR) = 1.63; 95% confidence interval (CI): 1.18-6.30], body mass index ≥ 24 kg/m2 (HR = 1.20, 95%CI: 1.07-5.89), pancreaticoduodenectomy (HR = 4.86, 95%CI: 1.20-8.31) and length of operation ≥ 241 min (HR = 2.97; 95%CI: 1.04-6.14) were significant (P = 0.010, P = 0.041, P = 0.017 and P = 0.012, respectively).

CONCLUSION

We found that aging is an independent risk factor for severe postoperative complications after PR. Our results might contribute to more informed decision-making for elderly patients.

Keywords: Pancreatectomy; Aged; Pancreatic cancer; Postoperative complications; Mortality

Core tip: Pancreatic resection is the only treatment with curative potential for pancreatic cancer and periampullary cancer, and it is a useful treatment for other benign diseases. But, compromised physiological reserve and comorbidities may counterindicate pancreatic resection in elderly patients. We found that aging is an independent risk factor for severe postoperative complications (grades IIIb-V). The potential deleterious effect of age on severe complications translates to a need for improvement in surgical management of elderly patients undergoing pancreatic resection. Our results might contribute to informed decision-making for elderly patients.