Department of General Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China.
Department of Biliopancreatic Surgery, Huadong Hospital, Fudan University, West 221 Yan-an Road, Shanghai, 200040, China.
Surg Endosc. 2020 May;34(5):2028-2034. doi: 10.1007/s00464-019-06982-w. Epub 2019 Jul 16.
The objective of the study is to evaluate the safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients by short-term surgical effects.
We retrospectively collected clinical data of 55 non-elderly patients (< 70 years), 27 elderly patients (≥ 70 years) underwent LPD, and 19 elderly patients underwent open pancreaticoduodenectomy (OPD) in biliopancreatic surgery department of Huadong Hospital, affiliated to Fudan University, from Jan 2015 to Jan 2018. Patients were divided into 3 groups: LPD aged < 70 years, LPD aged ≥ 70 years, and OPD aged ≥ 70 years, according to their age at admission and surgical approach in order to compare baseline characteristics and short-term surgical outcomes.
Totally 101 patients were included in this study; 59 cases were male; 42 cases were female; mean age was 66 years old. Elderly LPD patients seemed to have higher overall morbidity (41% vs. 20%, P = 0.05) compared to non-elderly patients. This difference is even more significant in our multivariable analysis model with an odds ratio of 4.48 (95% CI 1.31-17.87, P = 0.018). The 90-days mortality, operative time, estimated blood loss (EBL), and post-operative hospital stay (POHS) were similar in two groups. Elderly LPD patients had less EBL and shorter POHS than elderly OPD patients. However, the mortality and morbidity rate were comparable in these two groups.
Aging patients have higher overall morbidity than younger patients in LPD. However, for aging population who need to undergo pancreaticoduodenectomy, LPD might have some advantages over OPD.
本研究旨在通过短期手术效果评估腹腔镜胰十二指肠切除术（LPD）在老年患者中的安全性和可行性。
我们回顾性收集了 2015 年 1 月至 2018 年 1 月期间复旦大学附属华东医院胆胰外科接受 LPD 的 55 例非老年患者（<70 岁）、27 例老年患者（≥70 岁）和 19 例接受开腹胰十二指肠切除术（OPD）的老年患者的临床资料。根据入院时的年龄和手术方式，将患者分为 3 组：LPD 年龄<70 岁、LPD 年龄≥70 岁和 OPD 年龄≥70 岁，以比较基线特征和短期手术结果。
本研究共纳入 101 例患者；男 59 例，女 42 例；平均年龄为 66 岁。与非老年患者相比，老年 LPD 患者的总体并发症发生率似乎更高（41%比 20%，P=0.05）。在多变量分析模型中，这一差异更为显著，优势比为 4.48（95%CI 1.31-17.87，P=0.018）。两组患者的 90 天死亡率、手术时间、估计出血量（EBL）和术后住院时间（POHS）相似。老年 LPD 患者的 EBL 较少，POHS 较短，但两组患者的死亡率和并发症发生率相当。
与年轻患者相比，LPD 老年患者的总体并发症发生率更高。然而，对于需要接受胰十二指肠切除术的老年人群，LPD 可能比 OPD 具有一些优势。
