Perioperative safety of laparoscopic pancreaticoduodenectomy in elderly patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Guo , LI Qiang , XIONG Yongfu , XU Jian , QUAN Gang , WANG Hailin , ZHANG Lixin ,  LI Jingdong

Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary-Pancreatic-Intestinal of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

LI Jingdong, Email: lijingdong358@126.com

Keywords：

pancreaticoduodenectomy; laparoscope; elderly patient; safety

DOI：

10.7507/1007-9424.202103134

Video：

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Objective To investigate perioperative safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients (age ≥70 years old).Methods The retrospective cohort study was conducted. The clinicopathologic data of the patients underwent LPD and open pancreaticoduodenectomy (OPD) in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2019 were collected. The patients who met the inclusion and exclusion criteria were divided into LPD with aged ≥70 years old group (group A), OPD with aged ≥70 years old group (group B), and LPD with aged <70 years old group (group C). The baseline data, intraoperative situations, and postoperative situations were compared between the group A and group B, and between the group A and group C, respectively.Results ① There were no statistic differences in the age, gender, body mass index, hemoglobin, albumin, and total bilirubin, American Society of Anesthesiologists (ASA) grade, and comorbidity index before operation between the group A and group B (P>0.05). However, there were statistic differences in the hemoglobin, albumin, ASA grade, and comorbidity index before operation between the group A and group C (P<0.05). ② There were no significant differences in the operation time between the group A and group B (P>0.05), but the intraoperative blood loss of the group A was significantly less than the group B (P<0.05). The operation time, intraoperative blood loss, and conversion rate had no significant differences between the group A and group C (P>0.05). ③ There were no significant differences in the pathological pattern, tumor size, R0 resection rate, reoperative rate, and postoperative 90 d mortality between the group A and group B, and between the group A and group C, respectively. For the elderly patients, cases in the ICU, overall complications, specific complications (except for delayed gastric emptying) and Clavien-Dindo classification of complication after operation had no significant differences between the group A and group B (P>0.05), but there were more harvesting lymph nodes, lower postoperative pain score, shorter postoperative hospital stay, and less delayed gastric emptying cases in the group A than the group B (P<0.05). For the patients accepted LPD, there were no significant differences in the harvesting lymph nodes, postoperative pain score, postoperative hospital stay, and specific complications (except for pulmonary infection rate) between the group A and the group C (P>0.05), but the postoperative cases in the ICU were more, pulmonary infection rate was higher, overall complications rate and the ratio of Clavien-Dindo Ⅲ–Ⅳ classification of complication were higher in the group A as compared with the group C (P<0.05). Conclusion Compared with OPD, LPD might have some advantages in blood loss, harvesting lymph nodes, and recovery after surgery, even though perioperative safety of LPD in elderly patients is inferior to younger patients.

Citation： WU Guo, LI Qiang, XIONG Yongfu, XU Jian, QUAN Gang, WANG Hailin, ZHANG Lixin, LI Jingdong. Perioperative safety of laparoscopic pancreaticoduodenectomy in elderly patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(11): 1445-1449. doi: 10.7507/1007-9424.202103134 Copy

1.	Chapman BC, Gleisner A, Ibrahim-Zada I, et al. Laparoscopic pancreaticoduodenectomy: changing the management of ampullary neoplasms. Surg Endosc, 2018, 32(2): 915-922.
2.	Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
3.	Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
4.	Zureikat AH, Breaux JA, Steel JL, et al. Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg, 2011, 15(7): 1151-1157.
5.	Liang S, Jayaraman S. Getting started with minimally invasive pancreaticoduodenectomy: is it worth it? J Laparoendosc Adv Surg Tech A, 2015, 25(9): 712-719.
6.	Roscio F, Boni L, Clerici F, et al. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc, 2016, 30(10): 4372-4382.
7.	Zong L, Wu A, Wang W, et al. Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies. Oncotarget, 2017, 8(31): 51878-51887.
8.	Antoniou SA, Antoniou GA, Koch OO, et al. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66 483 patients. Surg Endosc, 2015, 29(2): 322-333.
9.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
10.	中華醫學會外科學分會胰腺外科學組, 中國醫療保健國際交流促進會胰腺病分會胰腺微創治療學組, 中國研究型醫院學會胰腺疾病專業委員會胰腺微創學組, 等. 腹腔鏡胰十二指腸切除手術專家共識(附: 手術流程與主要步驟). 中華外科雜志, 2017, 55(5): 335-339.
11.	孫備, 陳宏澤. 胰十二指腸切除術后消化道重建方式的選擇. 中華消化外科雜志, 2015, 14(11): 911-915.
12.	中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識(2017). 中華外科雜志, 2017, 55(5): 328-334.
13.	Murakami M, Shimizu J, Koga C, et al. Analysis of pancreaticoduodenectomy for elderly patients aged 75 years or older. Gan To Kagaku Ryoho, 2015, 42(12): 2351-2353.
14.	Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
15.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
16.	Eguchi T, Bains S, Lee MC, et al. Impact of increasing age on cause-specific mortality and morbidity in patients with stage Ⅰ non-small-cell lung cancer: a competing risks analysis. J Clin Oncol, 2017, 35(3): 281-290.
17.	Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg, 2006, 203(6): 865-877.
18.	Kim S, Brooks AK, Groban L. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging, 2014, 10: 13-27.
19.	Li H, Peng B. Total laparoscopic pancreaticoduodenectomy may benefit patients with severe impaired pulmonary function. Surg Laparosc Endosc Percutan Tech, 2015, 25(3): 266.
20.	Zhou J, Xin C, Xia T, et al. Laparoscopic pancreaticoduodenectomy in a-92-older Chinese patient for cancer of head of the pancreas: A case report. Medicine (Baltimore), 2017, 96(3): e5962.
21.	Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961.
22.	Chen K, Pan Y, Mou YP, et al. Surgical outcomes of laparoscopic distal pancreatectomy in elderly and octogenarian patients: a single-center, comparative study. Surg Endosc, 2019, 33(7): 2142-2151.

1. Chapman BC, Gleisner A, Ibrahim-Zada I, et al. Laparoscopic pancreaticoduodenectomy: changing the management of ampullary neoplasms. Surg Endosc, 2018, 32(2): 915-922.
2. Croome KP, Farnell MB, Que FG, et al. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg, 2015, 19(1): 189-194.
3. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
4. Zureikat AH, Breaux JA, Steel JL, et al. Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg, 2011, 15(7): 1151-1157.
5. Liang S, Jayaraman S. Getting started with minimally invasive pancreaticoduodenectomy: is it worth it? J Laparoendosc Adv Surg Tech A, 2015, 25(9): 712-719.
6. Roscio F, Boni L, Clerici F, et al. Is laparoscopic surgery really effective for the treatment of colon and rectal cancer in very elderly over 80 years old? A prospective multicentric case-control assessment. Surg Endosc, 2016, 30(10): 4372-4382.
7. Zong L, Wu A, Wang W, et al. Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies. Oncotarget, 2017, 8(31): 51878-51887.
8. Antoniou SA, Antoniou GA, Koch OO, et al. Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66 483 patients. Surg Endosc, 2015, 29(2): 322-333.
9. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987, 40(5): 373-383.
10. 中華醫學會外科學分會胰腺外科學組, 中國醫療保健國際交流促進會胰腺病分會胰腺微創治療學組, 中國研究型醫院學會胰腺疾病專業委員會胰腺微創學組, 等. 腹腔鏡胰十二指腸切除手術專家共識(附: 手術流程與主要步驟). 中華外科雜志, 2017, 55(5): 335-339.
11. 孫備, 陳宏澤. 胰十二指腸切除術后消化道重建方式的選擇. 中華消化外科雜志, 2015, 14(11): 911-915.
12. 中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識(2017). 中華外科雜志, 2017, 55(5): 328-334.
13. Murakami M, Shimizu J, Koga C, et al. Analysis of pancreaticoduodenectomy for elderly patients aged 75 years or older. Gan To Kagaku Ryoho, 2015, 42(12): 2351-2353.
14. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014, 260(4): 633-638.
15. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.
16. Eguchi T, Bains S, Lee MC, et al. Impact of increasing age on cause-specific mortality and morbidity in patients with stage Ⅰ non-small-cell lung cancer: a competing risks analysis. J Clin Oncol, 2017, 35(3): 281-290.
17. Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg, 2006, 203(6): 865-877.
18. Kim S, Brooks AK, Groban L. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging, 2014, 10: 13-27.
19. Li H, Peng B. Total laparoscopic pancreaticoduodenectomy may benefit patients with severe impaired pulmonary function. Surg Laparosc Endosc Percutan Tech, 2015, 25(3): 266.
20. Zhou J, Xin C, Xia T, et al. Laparoscopic pancreaticoduodenectomy in a-92-older Chinese patient for cancer of head of the pancreas: A case report. Medicine (Baltimore), 2017, 96(3): e5962.
21. Shin H, Song KB, Kim YI, et al. Propensity score-matching analysis comparing laparoscopic and open pancreaticoduodenectomy in elderly patients. Sci Rep, 2019, 9(1): 12961.
22. Chen K, Pan Y, Mou YP, et al. Surgical outcomes of laparoscopic distal pancreatectomy in elderly and octogenarian patients: a single-center, comparative study. Surg Endosc, 2019, 33(7): 2142-2151.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Perioperative safety of laparoscopic pancreaticoduodenectomy in elderly patients

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