Andreou Andreas, Aeschbacher Pauline, Candinas Daniel, Gloor Beat
Department of Visceral Surgery und Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2021 Feb 10;10(4):696. doi: 10.3390/jcm10040696.
As life expectancy is increasing, elderly patients are evaluated more frequently for resection of benign or malignant pancreatic lesions. However, the impact of age on postoperative morbidity, mortality, and treatment costs in octogenarian patients (≥80 years) undergoing major pancreatic surgery needs further investigation. The clinicopathological data of patients who underwent pancreatic surgery between January 2015 and March 2019 in a major hepatopancreatobiliary center in Switzerland were assessed. Postoperative outcomes and hospital costs of octogenarians and younger patients were compared in univariate and multivariate regression analysis. During the study period, 346 patients underwent pancreatic resection. Pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, and other procedures were performed in 54%, 20%, 13%, and 13% of patients, respectively. The major postoperative morbidity rate and postoperative mortality rate were 25% and 3.5%, respectively. A total of 39 patients (11%) were ≥80 years old, and 307 patients were <80 years old. The majority of octogenarians suffered from ductal adenocarcinoma, whereas among younger patients, other indications for a pancreatic resection were predominant (ductal adenocarcinoma 64% vs. 41%, = 0.006). Age ≥80 was associated with more frequent postoperative medical (pulmonary, cardiovascular) and surgical (high-grade pancreatic fistula, postoperative hemorrhage) complications. Postoperative mortality was significantly higher in octogenarians (15.4% vs. 2%, < 0.0001). This finding may be explained by the higher rate of type C pancreatic fistula (13% vs. 5%), resulting more frequently in postoperative hemorrhage (18% vs. 5%, = 0.002) among patients ≥80 years old. In the multivariate logistic regression analysis, patient age ≥80 years predicted postoperative mortality independently of the tumor entity and surgical technique ( = 0.013, OR 6.71, 95% CI [1.5-30.3]). Increased major postoperative morbidity was responsible for lower cost recovery in octogenarians (94% vs. 102%, = 0.046). In conclusion, patient age ≥80 years is associated with increased postoperative medical and surgical morbidity after major pancreatic surgery leading to lower cost recovery and a lower chance for successful resuscitation in patients requiring revisional surgery for postoperative hemorrhage and/or pancreatic fistula. In octogenarian patients suffering from pancreatic tumors, careful selection, and thorough prehabilitation is crucial to achieve the best postoperative and long-term oncologic outcomes.
随着预期寿命的增加，老年患者因良性或恶性胰腺病变而接受手术切除评估的频率更高。然而，年龄对接受大型胰腺手术的八旬老人（≥80岁）术后发病率、死亡率和治疗成本的影响仍需进一步研究。我们评估了2015年1月至2019年3月期间在瑞士一家大型肝胆胰中心接受胰腺手术患者的临床病理数据。在单因素和多因素回归分析中比较了八旬老人和年轻患者的术后结局及住院费用。在研究期间，346例患者接受了胰腺切除术。胰十二指肠切除术、胰腺远端切除术、全胰切除术及其他手术分别占患者总数的54%、20%、13%和13%。术后主要发病率和术后死亡率分别为25%和3.5%。共有39例患者（11%）年龄≥80岁，307例患者年龄<80岁。大多数八旬老人患有导管腺癌，而在年轻患者中，胰腺切除的其他指征更为常见（导管腺癌分别为64%和41%，P = 0.006）。年龄≥80岁与术后更频繁出现内科（肺部、心血管）和外科（高级别胰瘘、术后出血）并发症相关。八旬老人的术后死亡率显著更高（15.4%对2%，P < 0.0001）。这一发现可能是由于C型胰瘘发生率更高（13%对5%），导致≥80岁患者术后出血更频繁（18%对5%，P = 0.002）。在多因素逻辑回归分析中，患者年龄≥80岁独立于肿瘤类型和手术技术可预测术后死亡率（P = 0.013，OR 6.71，95%CI[×]1.5 - 30.3）。术后主要发病率增加导致八旬老人成本回收率降低（94%对102%，P = 0.046）。总之，患者年龄≥80岁与大型胰腺手术后内科和外科发病率增加相关，导致成本回收率降低，对于因术后出血和/或胰瘘需要再次手术的患者，成功复苏的机会也更低。对于患有胰腺肿瘤的八旬老人，仔细筛选和全面的术前康复对于实现最佳术后和长期肿瘤学结局至关重要。
