Papis Davide, Vagliasindi Alessio, Maida Pietro
General Surgery Unit, Del Mare Hospital, Naples, Italy.
General Surgery Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.
Ann Hepatobiliary Pancreat Surg. 2020 Feb;24(1):1-5. doi: 10.14701/ahbps.2020.24.1.1. Epub 2020 Feb 27.
Hepato-pancreatico-biliary (HPB) surgery includes major hepatic resection and pancreatic surgery, both procedures are complex and have a potentially high complication rate. The presence of centers of excellence with a high patients volume has lowered the complication and increased the resection rate. Increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Since old patients have more co-morbidities and decreased life expectancy, the benefit of these procedures need to be critically evaluated in this group. Analysis of the literature related to this argument demonstrated that pancreatoduodenectomy can be performed safely in selected elderly patients (70 years of age or older), with morbidity and mortality rates comparable those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumor or gallbladder carcinoma. More studies are needed regarding the subgroup of very elderly patients (80 years or older). Nevertheless, those elderly patients who will benefit from surgery must be adequatelly selected.
肝胰胆（HPB）手术包括主要的肝切除术和胰腺手术，这两种手术都很复杂，且潜在并发症发生率较高。拥有大量患者的卓越中心的存在降低了并发症发生率并提高了切除率。预期寿命的延长和总体健康状况的改善增加了符合大手术条件的老年患者数量。由于老年患者有更多的合并症且预期寿命缩短，因此需要对该群体中这些手术的益处进行严格评估。对与此论点相关的文献分析表明，在选定的老年患者（70岁及以上）中可以安全地进行胰十二指肠切除术，其发病率和死亡率与年轻患者相当。成本分析研究也证实了这一点，该研究报告两组的数据相似。对于患有肝细胞癌（HCC）、Klatskin瘤或胆囊癌的老年患者进行主要肝切除术也有类似的发现。对于非常老年患者（80岁及以上）这一亚组，还需要更多的研究。然而，必须充分挑选那些将从手术中受益的老年患者。
