Department of Hepatopancreatobiliary Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
Surg Endosc. 2019 Jul;33(7):2142-2151. doi: 10.1007/s00464-018-6489-1. Epub 2018 Oct 25.
Although recent reports have suggested the advantages of laparoscopic distal pancreatectomy (LDP), the potential benefits of this approach in elderly patients remain unclear. The aim of this study was to clarify the value of LDP in the elderly, in whom co-morbid diseases were generally more common.
Seventy elderly patients (≥ 70 years) and 264 non-elderly patients (40-69 years) who underwent LDP, and 48 elderly patients (≥ 70 years) who underwent open distal pancreatectomy (ODP) between May 2005 and May 2018 were studied. Demographics, intraoperative, and postoperative outcomes were compared.
Comorbidity was more common in elderly patients than in non-elderly patients who underwent LDP (57.1 vs. 38.3%, p < 0.01). The intraoperative factors, postoperative complication rate, and length of hospital stay were comparable in these two groups. Elderly patients who underwent LDP had a significantly shorter operative time (185.5 vs. 208.0 min, p = 0.02), less blood loss (191.0 vs. 291.8 mL, p < 0.01), and reduced length of postoperative hospital stay (11.4 vs. 15.1 days, p < 0.01) than elderly patients who had ODP. The overall complication rate tended to be lower in LDP group than that in ODP group (20.0 vs. 33.3%, p = 0.07).
LDP performed on the elderly is safe and feasible, leading to short-term outcomes similar to those of non-elderly patients. LDP could be an alternative to ODP in elderly patients, providing a lower rate of morbidity and favorable postoperative recovery and outcomes.
尽管最近的报道表明腹腔镜胰体尾切除术（LDP）具有优势，但这种方法在老年患者中的潜在益处尚不清楚。本研究旨在阐明 LDP 在合并症更为常见的老年患者中的价值。
研究纳入了 2005 年 5 月至 2018 年 5 月期间接受 LDP 的 70 例老年患者（≥70 岁）和 264 例非老年患者（40-69 岁），以及 48 例接受开腹胰体尾切除术（ODP）的老年患者（≥70 岁）。比较了这些患者的人口统计学、术中及术后结果。
与接受 LDP 的非老年患者相比，老年患者的合并症更为常见（57.1%比 38.3%，p<0.01）。这两组患者的术中因素、术后并发症发生率和住院时间无显著差异。接受 LDP 的老年患者的手术时间明显更短（185.5 比 208.0 分钟，p=0.02），出血量更少（191.0 比 291.8 毫升，p<0.01），术后住院时间更短（11.4 比 15.1 天，p<0.01），而接受 ODP 的老年患者则相反。LDP 组的总体并发症发生率低于 ODP 组（20.0%比 33.3%，p=0.07）。
对老年患者施行 LDP 是安全可行的，其短期结果与非老年患者相似。LDP 可作为老年患者的 ODP 替代方案，其发病率较低，术后恢复和结局良好。
