胰腺切除术：80 岁以上患者的 30 天和 90 天结果。

Pancreatic resections: 30 and 90-day outcomes in octogenarians.

机构信息

Division of Surgical Oncology, Helen F Graham Cancer Center and Research Institute, Christiana Care Health System, USA.

出版信息

Surg Oncol. 2021 Jun;37:101319. doi: 10.1016/j.suronc.2020.01.002. Epub 2020 Jan 27.

DOI:10.1016/j.suronc.2020.01.002

PMID:34103239

Abstract

BACKGROUND

Pancreatic tumors are frequently found in a geriatric population. Given that the median age of patients with pancreatic cancer is 70 years at diagnosis and the ubiquity of CT and MRI imaging has increased the detection of pancreas masses, pancreatic surgeons often find themselves operating on patients of advanced age. This study sought to evaluate the outcomes of pancreatic resection in an octogenarian population at a single institution with a dedicated surgical oncology team.

STUDY DESIGN

A retrospective chart review was performed for all patients undergoing pancreatic resection over a 13-year period at an academic community cancer center. Patient characteristics and operative outcomes were compared between patients aged 80 and older, and those younger than 80. Student t-tests, Fisher's exact test, and Kruskal-Wallis tests were used for univariate analyses.

RESULTS

Over the 13-year period, a total of 48 patients of 403 undergoing pancreatic resections were aged 80 or older. Of these 48 patients, 35 underwent pancreaticoduodenectomy (Whipple) and 13 underwent distal pancreatectomy. Patient characteristics including ASA classification were similar among the two age groups. The procedures themselves were equally complicated with similar operative times, transfusion requirements, estimated blood losses, and portal vein resections. The number and severity of complications such as delayed gastric emptying and pancreatic leak were not statistically different between the two groups. Additionally, the 30-day reoperation, readmission, and mortality rates were not statistically different. Outcomes at 90-days revealed an increased rate of readmission amongst octogenarians who underwent Whipple without an increase in rates of major complications. The total number of deaths in the octogenarian group was 3 (6.2%) vs. 6 (1.7%) in the non-octogenarian group (p = 0.080). The median length of stay was similar amongst the two age groups.

CONCLUSIONS

At a large-volume academic community cancer center with a dedicated surgical oncology team, highly selected octogenarians can undergo pancreatic resection safely with outcomes that do not differ significantly from their younger counterparts.

摘要

背景

胰腺肿瘤在老年人群中经常被发现。鉴于胰腺癌患者的中位诊断年龄为 70 岁，而且 CT 和 MRI 成像的普及使胰腺肿块的检出率增加，胰腺外科医生经常为高龄患者进行手术。本研究旨在评估一个有专门肿瘤外科团队的学术社区癌症中心对 80 岁以上人群进行胰腺切除术的结果。

研究设计

对在学术社区癌症中心接受胰腺切除术的所有患者进行了 13 年的回顾性图表审查。比较了年龄在 80 岁及以上和年龄在 80 岁以下的患者的患者特征和手术结果。使用 Student t 检验、Fisher 确切检验和 Kruskal-Wallis 检验进行单变量分析。

结果

在 13 年期间，共有 403 名接受胰腺切除术的患者年龄在 80 岁或以上。在这 48 名患者中，35 名接受了胰十二指肠切除术（Whipple），13 名接受了胰体尾切除术。两组患者的 ASA 分级等特征相似。手术本身同样复杂，手术时间、输血需求、估计失血量和门静脉切除相似。两组患者的并发症数量和严重程度，如胃排空延迟和胰漏，没有统计学差异。此外，30 天内再次手术、再次入院和死亡率也没有统计学差异。90 天的结果显示，接受 Whipple 手术的 80 岁以上患者的再入院率增加，但主要并发症发生率没有增加。80 岁以上组的总死亡人数为 3（6.2%），而非 80 岁以下组为 6（1.7%）（p=0.080）。两组的中位住院时间相似。