General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy.
Institute of Clinical Physiology, National Council of Research, Pisa, Italy.
Aging Clin Exp Res. 2020 May;32(5):935-950. doi: 10.1007/s40520-019-01276-6. Epub 2019 Jul 25.
More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases.
To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk.
A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared.
Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients.
Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.
超过 60%的胰腺癌患者年龄≥65 岁。手术是恶性胰腺肿瘤的唯一潜在治愈性治疗方法，也是良性疾病的有效治疗方法。
评估与年轻患者和低麻醉风险的老年患者相比，ASA 风险评分 4 的老年患者接受胰腺切除术的结果。
回顾了 2010 年至 2017 年间连续 345 例接受胰腺切除术的患者。我们根据手术时的年龄将患者分为三组：<65 岁（组 A）、65-74 岁（组 B）和≥75 岁（组 C）。组 C 患者分为 ASA 1-3 与 ASA 4 两组，并进行比较。
组 A 有 117 例（34%）患者，组 B 有 128 例（37%）患者，组 C 有 100 例（29%）患者。组 C 的合并症和 ASA 4 发生率显著较高（p<0.05），且总体术后并发症发生率较高（p<0.01），这是由于术后内科并发症发生率较高。在总体手术并发症和术后死亡率方面，三组之间无差异。组 C 的平均总生存期明显较低（p<0.01），但癌症死亡率无差异。在组 C 中，ASA 1-3 与 ASA 4 患者之间的手术并发症（p=0.59）、死亡率（p=0.34）和平均总生存期（p=0.53）无差异。
老年胰腺疾病患者不应因年龄而被排除在手术治疗之外，年龄≥75 岁的患者 ASA 4 不应作为绝对禁忌证。
