Emmen Anouk M L H, Jones Leia R, Wei Kongyuan, Busch Olivier, Shen Baiyong, Fusai Giuseppe K, Shyr Yi-Ming, Khatkov Igor, White Steve, Boggi Ugo, Kerem Mustafa, Molenaar I Q, Koerkamp Bas G, Saint-Marc Olivier, Dokmak Safi, van Dieren Susan, Rozzini Renzo, Festen Sebastiaan, Liu Rong, Jang Jin-Young, Besselink Marc G, Hilal Mohammed A
Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy; Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands.
Department of Surgery, Chinese PLA General Hospital, Beijing, China.
HPB (Oxford). 2025 Jan;27(1):102-110. doi: 10.1016/j.hpb.2024.10.008. Epub 2024 Oct 18.
Pancreatoduodenectomy in elderly patients may be associated with increased postoperative mortality, but studies in minimally invasive pancreatoduodenectomy (MIPD) are scarce.
International multicenter retrospective study including patients aged >60 years undergoing MIPD (robot-assisted and laparoscopic) and open pancreatoduodenectomy (OPD), were categorized by age: 60-69, 70-79, and 80+ years. In each category, propensity score matching (PSM) was performed (1:1 ratio) between MIPD and OPD. Primary outcome was 30-day/in-hospital mortality.
Among 3820 patients, we matched 1468 patients aged 60-69, 1154 patients aged 70-79, and 196 patients aged 80+ years. In patients aged 60-69 and 70-79 years, MIPD was associated with longer operative time, less blood loss and a longer length of stay. Major morbidity was higher after MIPD with similar 30-day/in-hospital mortality. The R0 resection rate was higher after MIPD. In patients aged 80+ years, besides a longer operative time in MIPD, outcomes were comparable between both groups.
This study found no evidence that increasing age worsens mortality of MIPD. MIPD was associated with longer operative time, higher rate of major morbidity, prolonged length of stay versus less blood loss and a higher R0 resection in patients aged 60-69 and 70-79 years. These differences continue in patients aged 80+ years, but became less evident.
老年患者行胰十二指肠切除术可能与术后死亡率增加有关，但关于微创胰十二指肠切除术（MIPD）的研究较少。
一项国际多中心回顾性研究，纳入年龄>60岁接受MIPD（机器人辅助和腹腔镜）及开放胰十二指肠切除术（OPD）的患者，按年龄分为：60 - 69岁、70 - 79岁和80岁及以上。在每个年龄段，对MIPD和OPD进行倾向评分匹配（1:1比例）。主要结局为30天/住院死亡率。
在3820例患者中，我们匹配了1468例60 - 69岁患者、1154例70 - 79岁患者和196例80岁及以上患者。在60 - 69岁和70 - 79岁的患者中，MIPD与手术时间更长、失血更少和住院时间更长有关。MIPD后的主要并发症发生率更高，但30天/住院死亡率相似。MIPD后的R0切除率更高。在80岁及以上的患者中，除了MIPD的手术时间更长外，两组的结局相当。
本研究未发现年龄增加会使MIPD死亡率恶化的证据。在60 - 69岁和70 - 79岁的患者中，MIPD与手术时间更长、主要并发症发生率更高、住院时间延长、失血更少以及R0切除率更高有关。这些差异在80岁及以上的患者中仍然存在，但不太明显。
