Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis
Abstract
:1. Introduction
2. Patients and Methods
2.1. Study Design and Reporting
2.2. Patient Collective
2.3. Data Collection and Variables
2.4. Surgical Techniques and Histopathological Analysis
2.5. Perioperative Therapy
2.6. Statistical Analysis
2.7. Ethics
3. Results
3.1. Descriptive Analysis of All Pancreatic Resections and Histopathology
3.2. Postoperative Outcome after Pancreatoduodenectomy (PD) and Distal Pancreatectomy (DP)
3.3. Oncological Outcome for Pancreatic Adenocarcinoma Patients after PD and DP
4. Discussion
4.1. Perioperative Outcome
4.2. Oncological Outcome
4.3. Outlook
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Age Group (Years) | <70 | 70–79 | 80–89 | ALL |
---|---|---|---|---|
Type of procedure (N) | ||||
PD | ||||
- Whipple | 42 | 25 | 10 | 77 |
PPPD | 299 | 160 | 42 | 501 |
- laparoscopic (ass.) PPPD | 118 | 77 | 14 | 209 |
DP | ||||
- conventional | 104 | 41 | 12 | 157 |
- laparoscopic | 97 | 49 | 6 | 151 |
- Appleby | 2 | 1 | - | 3 |
Total pancreatectomy | ||||
- conventional | 32 | 20 | - | 52 |
- laparoscopic | 4 | 1 | - | 5 |
Segmental resection | ||||
- conventional | 9 | 2 | - | 11 |
- laparoscopic | 7 | 2 | - | 9 |
Enucleation | ||||
- conventional | 3 | 2 | - | 5 |
- laparoscopic | 4 | 1 | - | 5 |
Others | ||||
- Frey | 33 | 4 | 1 | 38 |
- Partington-Rochelle | 7 | - | - | 7 |
Histopathologic diagnosis (N) | ||||
PAC | ||||
- head | 213 | 145 | 37 | 395 |
- body | 27 | 17 | 2 | 46 |
- tail | 30 | 27 | 8 | 65 |
Ampullary carcinoma | 35 | 25 | 6 | 66 |
Carcinoma of the DBD | 22 | 24 | 10 | 56 |
Duodenal carcinoma | 12 | 8 | 3 | 23 |
Neuroendocrine tumor | 82 | 22 | 1 | 105 |
Pancreatic metastasis | 24 | 9 | 1 | 34 |
IPMN | 66 | 51 | 6 | 123 |
Adenoma and other benign | 94 | 32 | 8 | 134 |
CP | 156 | 25 | 3 | 184 |
N total (%) | 761 (61.8) | 385 (31.3) | 85 (6.9) | 1231 |
N PD+DP only (excl. Appleby) (%) | 660 (60.2) | 352 (32.1) | 84 (7.7) | 1096 |
N periampullary carcinoma only (%) | 339 (52.1) | 246 (37.8) | 66 (10.1) | 651 |
N PAC only (%) | 270 (53.4) | 189 (37.4) | 47 (9.3) | 506 |
Age Group (Years) | <70 (N = 660) | 70–79 (N = 352) | 80–89 (N = 84) | p |
---|---|---|---|---|
Preoperative | ||||
Gender, N (%) | ||||
- F | 286 (43.3) | 163 (46.3) | 42 (50) | |
- M | 374 (56.7) | 189 (53.7) | 42 (50) | 0.403 |
BMI, N (%) | ||||
- <18.5 kg/m2 | 30 (4.6) | 14 (4) | 2 (2.4) | |
- 18.5–24.9 kg/m2 | 324 (49.6) | 162 (46.6) | 44 (52.4) | |
- 25–29.9 kg/m2 | 199 (30.5) | 130 (37.4) | 32 (38.1) | |
- ≥30 kg/m2 | 100 (15.3) | 42 (12.1) | 6 (7.1) | 0.124 |
ASA, N (%) | ||||
- I | 51 (7.8) | 9 (2.6) | 1 (1.2) | |
- II | 371 (56.6) | 141 (40.5) | 31 (37.3) | |
- III | 220 (33.6) | 190 (54.6) | 46 (55.4) | |
- IV | 13 (2) | 8 (2.3) | 5 (6) | <0.001 |
Comorbidities, N (%) | ||||
- overall ‚Yes’ | 453 (69.6) | 306 (88.7) | 74 (89.2) | <0.001 |
- CAD | 64 (9.9) | 65 (19) | 20 (24.1) | <0.001 |
- AHT | 257 (39.8) | 248 (72.1) | 65 (78.3) | <0.001 |
- Pulmonary | 120 (18.6) | 65 (19) | 13 (15.7) | 0.782 |
- Renal | 52 (8) | 55 (16.1) | 18 (22) | <0.001 |
- Hepatic | 144 (22.6) | 79 (23.4) | 20 (25.3) | 0.852 |
- DM | 105 (16.1) | 87 (24.9) | 19 (22.6) | 0.048 |
- Anemia (<10 g/dL) | 25 (3.8) | 28 (8) | 5 (6) | 0.018 |
Alcohol abuse, N (%) | 93 (14.2) | 31 (8.9) | 2 (2.4) | 0.001 |
Nicotine consume, N (%) | 230 (35) | 52 (14.9) | 5 (6) | <0.001 |
Intraoperative | ||||
Procedure, N (%) | ||||
- PD (lap./conv.) | 459 (69.5) | 262 (74.4) | 66 (78.6) | |
- DP (lap./conv.) | 201 (30.5) | 90 (25.6) | 18 (21.4) | 0.092 |
Histopathology, N (%) | ||||
- Carcinoma | 310 (47) | 228 (64.8) | 65 (77.4) | |
- Metastasis | 20 (3) | 7 (2) | 1 (1.2) | |
- NET | 69 (10.5) | 20 (5.7) | 1 (1.2) | |
- benign | 261 (39.5) | 97 (27.6) | 17 (20.2) | <0.001 |
Portal vein resection, N (%) | 94 (14.3) | 75 (21.3) | 19 (22.6) | 0.008 |
Multivisceral resection, N (%) | ||||
- + liver | 44 (6.7) | 14 (4) | 4 (4.8) | 0.191 |
- + stomach | 18 (2.7) | 11 (3.1) | 3 (3.6) | 0.881 |
- + colon | 24 (3.7) | 16 (4.5) | 2 (2.4) | 0.600 |
Operative time (min), mean (SD) | 380 (119) | 384 (107) | 375 (114) | 0.792 |
Blood loss (cc), mean (SD) | 726 (591) | 683 (595) | 743 (752) | 0.582 |
PRBC received, N (%) | 78 (11.9) | 48 (13.7) | 15 (17.9) | 0.264 |
Postoperative | ||||
Biliary leak, N (%) | 18 (2.7) | 11 (3.1) | 1 (1.2) | 0.627 |
DGE (ISGPS-grade B+C), N (%) | 68 (10.9) | 67 (20.9) | 14 (17.7) | <0.001 |
POPF (ISGPS-grade B+C), N (%) | 180 (27.4) | 109 (31.1) | 20 (23.8) | 0.303 |
PPH (ISGPS-grade B+C), N (%) | 51 (7.8) | 28 (8) | 7 (8.3) | 0.980 |
SSI, N (%) | 83 (12.7) | 49 (14) | 11 (13.1) | 0.838 |
Reoperation, N (%) | 94 (14.3) | 57 (16.2) | 12 (14.5) | 0.709 |
Intervention, N (%) | 172 (26.3) | 112 (32) | 20 (24.1) | 0.111 |
Sepsis, N (%) | 25 (3.8) | 16 (4.6) | 5 (6) | 0.609 |
Renal failure, N (%) | 20 (3) | 15 (4.3) | 4 (4.8) | 0.501 |
Pneumonia, N (%) | 34 (5.2) | 22 (6.3) | 5 (6) | 0.761 |
Thromboembolism, N (%) | 17 (2.6) | 14 (4) | 3 (3.6) | 0.458 |
Reintubation, N (%) | 30 (4.6) | 24 (6.9) | 3 (3.6) | 0.232 |
ICU stay (days), mean (SD) | 6.1 (7.3) | 7.3 (10.0) | 6.8 (5.4) | 0.192 |
Hospital stay (days), mean (SD) | 19.5 (14.7) | 22.1 (15.7) | 20.5 (12.8) | 0.031 |
Mortality, N (%) | 15 (2.3) | 11 (3.1) | 5 (6) | 0.187 |
Age Group (Years) | <70 (N = 15) | 70–79 (N = 11) | 80–89 (N = 5) |
---|---|---|---|
Surgical | |||
POPF grade C | 1 | 1 | 3 |
PPH grade C | 4 | 6 | - |
Bowel ischemia | 1 | 1 | 1 |
Portal vein thrombosis | 1 | - | - |
Sepsis, MOF (abdominal focus) | 2 | 1 | - |
Medical | |||
Sepsis, MOF (pulmonary focus) | 1 | 1 | - |
Myocardial infarction | 2 | - | - |
Thromboembolism | 1 | 1 | - |
Cerebral insult | 1 | - | 1 |
Metabolic encephalopathy | 1 | - | - |
Variable | Univariate Analysis | Multivariable Analysis | ||
---|---|---|---|---|
OR | p | OR (95% CI) | p | |
Age group | ||||
- <70 vs. 80–89 | 0.39 | 0.075 | ||
- 70–79 vs. 80–89 | 0.51 | 0.223 | ||
- 70–79 vs. <70 | 1.3 | 0.511 | ||
Gender | ||||
- F vs. M | 0.64 | 0.232 | ||
BMI | ||||
- 18.5–24.9 vs. <18.5 kg/m2 | 1.22 | 0.849 | ||
- 25–29.9 vs. <18.5 kg/m2 | 1.41 | 0.743 | ||
- ≥30 vs. <18.5 kg/m2 | 1.57 | 0.683 | ||
ASA | ||||
- II vs. I | 1.01 | 0.992 | ||
- III vs. I | 3.04 | 0.281 | ||
- IV vs. I | 0.00 | 0.998 | ||
Comorbidities | ||||
- overall ‚Yes’ vs. ‚No’ | 2.92 | 0.079 | ||
Alcohol abuse | ||||
- ‚Yes’ vs. ‚No’ | 1.10 | 0.866 | ||
Nicotine consume | ||||
- ‚Yes’ vs. ‚No’ | 1.28 | 0.522 | ||
Procedure | ||||
- PD vs. DP | 2.16 | 0.117 | ||
Histopathology | ||||
- Carcinoma vs. benign | 1.08 | 0.848 | ||
- Metastasis vs. begign | 2.55 | 0.240 | ||
- NET vs. benign | 0.00 | 0.997 | ||
Portal vein resection | ||||
- ‚Yes’ vs. ‚No’ | 0.49 | 0.243 | ||
Multivisceral resection, any | ||||
- ‚Yes’ vs. ‚No’ | 0.7 | 0.567 | ||
Operative time | ||||
- per minute | 1.01 | 0.087 | ||
PRBC received | ||||
- ‚Yes’ vs. ‚No’ | 1.58 | 0.320 | ||
Biliary leak | ||||
- ‚Yes’ vs. ‚No’ | 6.11 | 0.002 | 0.52 (0.29–9.29) | 0.654 |
DGE (ISGPS-grade B+C) | ||||
- ‚Yes’ vs. ‚No’ | 3.95 | 0.134 | ||
POPF (ISGPS-grade B+C) | ||||
- ‚Yes’ vs. ‚No’ | 5.06 | <0.001 | 0.50 (0.10–2.50) | 0.399 |
PPH (ISGPS-grade B+C) | ||||
- ‚Yes’ vs. ‚No’ | 11.02 | <0.001 | 1.72 (0.34–8.59) | 0.509 |
SSI | ||||
- ‚Yes’ vs. ‚No’ | 2.61 | 0.024 | 0.20 (0.03–1.28) | 0.089 |
Reoperation | ||||
- ‚Yes’ vs. ‚No’ | 27.84 | <0.001 | 5.40 (0.82–35.60) | 0.08 |
Intervention | ||||
- ‚Yes’ vs. ‚No’ | 7.94 | <0.001 | 5.40 (0.82–35.60) | 0.884 |
Sepsis | ||||
- ‚Yes’ vs. ‚No’ | 118.6 | <0.001 | 7.84 (1.18–52.21) | 0.033 |
Renal failure | ||||
- ‚Yes’ vs. ‚No’ | 51.53 | <0.001 | 1.09 (0.08–13.98) | 0.949 |
Pneumonia | ||||
- ‚Yes’ vs. ‚No’ | 11.7 | <0.001 | 1.55 (0.25–9.73) | 0.638 |
Thromboembolism, N (%) | ||||
- ‚Yes’ vs. ‚No’ | 11.64 | <0.001 | 0.91 (0.08–10.50) | 0.938 |
Reintubation, N (%) | ||||
- ‚Yes’ vs. ‚No’ | 106.7 | <0.001 | 8.53 (1.40–52.18) | 0.020 |
ICU stay | ||||
- Per day | 1.1 | <0.001 | * | * |
Hospital stay | ||||
- Per day | 1.04 | <0.001 | 1.024 (0.99–1.06) | 0.145 |
Age Group (Years) | <70 (N = 243) | 70–79 (N = 173) | 80–89 (N = 47) | p |
---|---|---|---|---|
Tumor grade, N (%) | ||||
- 1 | 7 (3.2) | 2 (1.2) | 2 (4.3) | |
- 2 | 122 (55) | 103 (63.6) | 20 (42.6) | |
- 3 | 91 (41) | 56 (34.6) | 24 (51.1) | |
- 4 | 2 (0.9) | 1 (0.6) | 1 (2.1) | 0.193 |
Tumor size (mm), mean (SD) | 34.2 (17.4) | 32.7 (16.6) | 31.6 (11.2) | 0.523 |
pT (UICC), N (%) | ||||
- 0 | 1 (0.4) | 0 | 0 | |
- 1 | 18 (7.5) | 5 (2.9) | 1 (2.1) | |
- 2 | 41 (17.2) | 30 (17.6) | 11 (23.4) | |
- 3 | 175 (73.2) | 131 (77.1) | 34 (72.3) | |
- 4 | 4 (1.7) | 4 (2.4) | 1 (2.1) | 0.515 |
pN (UICC), N (%) | ||||
- 0 | 74 (30.8) | 53 (31.2) | 10 (40.4) | |
- 1 | 152 (63.3) | 103 (60.6) | 25 (53.2) | |
- 2 | 14 (5.8) | 14 (8.2) | 3 (6.4) | 0.605 |
LNR, mean (SD) | 0.17 (0.20) | 0.17 (0.18) | 0.14 (0.16) | 0.559 |
pV (UICC), N (%) | ||||
- 0 | 207 (88.5) | 148 (88.6) | 43 (91.5) | |
- 1 | 25 (10.7) | 19 (11.4) | 4 (8.5) | |
- 2 | 2 (0.9) | 0 | 0 | 0.708 |
pL (UICC), N (%) | ||||
- 0 | 96 (41) | 68 (40.2) | 24 (51.1) | |
- 1 | 138 (59) | 101 (59.8) | 23 (48.9) | 0.39 |
pPn (UICC), N (%) | ||||
- 0 | 56 (24.5) | 38 (23.2) | 12 (26.7) | |
- 1 | 173 (75.5) | 126 (76.8) | 33 (73.3) | 0.882 |
pM (UICC), N (%) | ||||
- 0 | 213 (91.4) | 154 (92.8) | 44 (95.7) | |
- 1 | 20 (8.6) | 12 (7.2) | 2 (4.3) | 0.594 |
R-status, N (%) | ||||
- 0 | 180 (75.9) | 133 (78.2) | 35 (74.5) | |
- 1 | 53 (22.4) | 33 (19.4) | 1 (23.4) | |
- 2 | 4 (1.7) | 4 (2.4) | 1 (2.1) | 0.934 |
Neoadjuvant/induction therapy, N (%) | ||||
- RTx | 6 (2.5) | 4 (2.3) | 0 | 0.558 |
- CTx | 31 (12.8) | 13 (7.5) | 0 | 0.013 |
Adjuvant CTx, N (%) | ||||
- yes, received | 146 (61.3) | 91 (53.2) | 12 (26.1) | |
- no | 20 (8.4) | 24 (14) | 16 (34.8) | |
- intended (LFO) | 72 (30.3) | 56 (32.7) | 18 (39.1) | <0.001 |
Variable | Univariate Analysis | Multivariable Analysis | ||
---|---|---|---|---|
HR | p | HR (95% CI) | p | |
Age group | ||||
- <70 vs. 80–89 | 0.70 | 0.089 | ||
- 70–79 vs. 80–89 | 0.88 | 0.542 | ||
- 70–79 vs. <70 | 1.26 | 0.079 | ||
Gender | ||||
- F vs. M | 0.96 | 0.711 | ||
BMI | ||||
- 18.5–24.9 vs. <18.5 kg/m2 | 0.84 | 0.568 | ||
- 25–29.9 vs. <18.5 kg/m2 | 0.76 | 0.381 | ||
- ≥30 vs. <18.5 kg/m2 | 0.74 | 0.381 | ||
ASA | ||||
- II vs. I | 1.01 | 0.966 | ||
- III vs. I | 0.96 | 0.880 | ||
- IV vs. I | 1.96 | 0.145 | ||
Comorbidities | ||||
- overall ‚Yes’ vs. ‚No’ | 1.22 | 0.165 | ||
Alcohol abuse | ||||
- ‚Yes’ vs. ‚No’ | 1.12 | 0.611 | ||
Nicotine consume | ||||
- ‚Yes’ vs. ‚No’ | 1.22 | 0.211 | ||
Procedure | ||||
- PD vs. DP | 1.39 | 0.060 | ||
Portal vein resection | ||||
- ‚Yes’ vs. ‚No’ | 1.51 | 0.001 | 1.25 (0.93–1.68) | 0.136 |
Multivisceral resection, any | ||||
- ‚Yes’ vs. ‚No’ | 1.06 | 0.752 | ||
Operative time | ||||
- per minute | 1.002 | <0.001 | 1.001 (1.000–1.002) | 0.096 |
PRBC received | ||||
- ‚Yes’ vs. ‚No’ | 1.33 | 0.055 | ||
Tumor grade | ||||
- ‚G1+2’ vs. ‚G3+4’ | 0.58 | <0.001 | 0.59 (0.45–0.78) | <0.001 |
Tumor size | ||||
- per mm | 1.004 | 0.216 | ||
pT (UICC) | ||||
- ‚T1+2’ vs. ‚T3+4’ | 0.54 | 0.002 | 0.79 (0.49–1.28) | 0.344 |
pN (UICC) | ||||
- ‚N0’ vs. ‚N1+2’ | 0.53 | <0.001 | 1.07 (0.70–1.64) | 0.763 |
LNR | ||||
- overall (0 > 1) | 9.35 | <0.001 | 3.93 (1.69–9.12) | 0.001 |
pV (UICC) | ||||
- ‚V0’ vs. ‚V1+2’ | 0.50 | <0.001 | 0.67 (0.45–1.00) | 0.050 |
pL (UICC) | ||||
- ‚L0’ vs. ‚L1’ | 0.54 | <0.001 | 0.73 (0.51–1.05) | 0.086 |
pPn (UICC) | ||||
- ‚Pn0’ vs. ‚Pn1’ | 0.58 | 0.001 | 0.83 (0.57–1.19) | 0.299 |
pM (UICC) | ||||
- ‚M0’ vs. ‚M1’ | 0.72 | 0.148 | ||
R-Status | ||||
- ‚R0’ vs. ‚R1+2’ | 0.51 | <0.001 | 0.65 (0.48–0.89) | 0.008 |
Neoadjuvant/induction therapy | ||||
- ‚Yes’ vs. ‚No’ | 1.06 | 0.799 | ||
Adjuvant CTx | ||||
- ‚Yes’ vs. ‚No’ | 0.95 | 0.826 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Ruess, D.A.; Biesel, E.A.; Kühlbrey, C.M.; Chikhladze, S.; Hipp, J.; Lünstedt, J.; Fichtner-Feigl, S.; Hopt, U.T.; Wittel, U.A. Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis. Surgeries 2020, 1, 30-45. https://doi.org/10.3390/surgeries1010005
Ruess DA, Biesel EA, Kühlbrey CM, Chikhladze S, Hipp J, Lünstedt J, Fichtner-Feigl S, Hopt UT, Wittel UA. Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis. Surgeries. 2020; 1(1):30-45. https://doi.org/10.3390/surgeries1010005
Chicago/Turabian StyleRuess, Dietrich A., Esther A. Biesel, Christian M. Kühlbrey, Sophia Chikhladze, Julian Hipp, Jost Lünstedt, Stefan Fichtner-Feigl, Ulrich T. Hopt, and Uwe A. Wittel. 2020. "Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis" Surgeries 1, no. 1: 30-45. https://doi.org/10.3390/surgeries1010005
APA StyleRuess, D. A., Biesel, E. A., Kühlbrey, C. M., Chikhladze, S., Hipp, J., Lünstedt, J., Fichtner-Feigl, S., Hopt, U. T., & Wittel, U. A. (2020). Pancreatic Resection in Older Patients: A Retrospective Single-Center Outcome Analysis. Surgeries, 1(1), 30-45. https://doi.org/10.3390/surgeries1010005