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Zhang Y, Hu M, Xu D, Li X, Li A, Huang J. Investigation on the psychological impact of grade B or C pancreatic fistula of post pancreatoduodenectomy (PD) on surgeon-in-chief and its related factors. Curr Probl Surg 2024; 61:101428. [PMID: 38161062 DOI: 10.1016/j.cpsurg.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Yan Zhang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Manqin Hu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xincheng Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ao Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Shyr BS, Yu JH, Chen SC, Wang SE, Shyr YM, Shyr BU. Surgical Risks and Survival Outcomes in Robotic Pancreaticoduodenectomy for the Aged Over 80: A Retrospective Cohort Study. Clin Interv Aging 2023; 18:1405-1414. [PMID: 37645471 PMCID: PMC10461739 DOI: 10.2147/cia.s411391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
Aim Whether to execute pancreaticoduodenectomy or not for older people could pose a dilemma. This study clarifies the safety and justification of robotic pancreaticoduodenectomy (RPD) for older individuals over 80. Methods A total of 500 patients undergoing RPD were divided into group O (≥ 80 y/o) and group Y (< 80 y/o) for comparison. Results There were 62 (12.4%) patients in group O. Surgical mortality was 1.6% for overall patients and higher in group O, 6.5% vs 0.9%; p = 0.001. The surgical complication was comparable between groups O and Y. Delayed gastric emptying and bile leakage were higher in group O, 9.7% vs 2.5%; p = 0.004, and 6.5% vs 0.9%; p = 0.001, respectively. Length of stay was also longer in group O, with a median of 26 vs 19 days; p = 0.001. Survival outcome after RPD was poorer in group O for overall periampullary adenocarcinomas, with a 5-year survival of 48.1% vs 51.2%; p = 0.025 and also for the subgroup of pancreatic head adenocarcinoma, with a 3-year survival of 27.4% vs 42.5%; p = 0.030. Conclusion RPD is safe and justified for the selected octogenarians and even nonagenarians, whoever is fit for a major operation. Nevertheless, pancreatic head cancer and higher mortality risk for the aged over 80 with advanced ASA score ≥ 3 should be informed as part of counselling in offering RPD.
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Affiliation(s)
- Bor-Shiuan Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Jwo-Huey Yu
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Shih-Chin Chen
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Shin-E Wang
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Yi-Ming Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Bor-Uei Shyr
- General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
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Contemporary outcomes of pancreaticoduodenectomy for benign and precancerous cystic lesions. HPB (Oxford) 2022; 24:1416-1424. [PMID: 35140056 DOI: 10.1016/j.hpb.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/10/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The decision to undertake pancreaticoduodenectomy for benign and precancerous lesions has historically relied on outcomes data from operations for cancer. We aimed to describe risks for these specific patients and identify the highest risk groups. METHODS The ACS-NSQIP pancreatic targeted data was queried for pancreaticoduodenectomies for benign and pre-cancerous neoplasms from 2014 to 2018. Baseline characteristics, operative techniques and outcomes were examined. Multivariate regression was performed to identify predictors of major complications. RESULTS 748 patients underwent pancreaticoduodenectomy for (n = 541,72.3%) IPMN, (n = 87,11.6%) MCN, (n = 78,10.4%) serous cystadenoma, and (n = 42,5.6%) solid pseudopapillary neoplasm. Median LOS was 8 days. Major complications (n = 135,18.0%), non-home discharges (n = 83,11.1%) and readmissions (n = 153,20.5%) occurred frequently. In patients ≥ 80 years of age (n = 37), major complications (n = 11,29.7%) and non-home discharge (n = 9,24.3%) were quite common. 5-item modified frailty index ≥ 0.4 (OR 1.84,95%CI 1.06-3.19,p = 0.030), Male sex (OR 1.729,95%CI 1.152-2.595,p = 0.008), Age ≥ 65 (OR 1.63,95%CI 1.05-2.54,p = 0.29) and African-American race (OR 2.50,95%CI 1.22-5.16,p = 0.013) were independent predictors of major morbidity. CONCLUSIONS Pancreaticoduodenectomies in this setting have high rates of major complications. Morbidity extends beyond the index hospitalization, with frequent readmission and non-home discharge. Patient specific factors, rather than technical or disease factors predicted outcomes. In certain patients, particularly those older than 80, the morbidity of this operation may exceed the cancer prevention benefits.
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Attard JA, Al-Sarireh B, Bhogal RH, Farrugia A, Fusai G, Harper S, Hidalgo-Salinas C, Jah A, Marangoni G, Mortimer M, Pizanias M, Prachialias A, Roberts KJ, Sew Hee C, Soggiu F, Srinivasan P, Chatzizacharias NA. Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case-control study. Br J Surg 2021; 109:89-95. [PMID: 34750618 DOI: 10.1093/bjs/znab374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) is frequently the surgical treatment indicated for a number of pathologies. Elderly patients may be denied surgery because of concerns over poor perioperative outcomes. The aim of this study was to evaluate postoperative clinical outcomes and provide evidence on current UK practice in the elderly population after PD. METHODS This was a multicentre retrospective case-control study of octogenarians undergoing PD between January 2008 and December 2017, matched with younger controls from seven specialist centres in the UK. The primary endpoint was 90-day mortality. Secondary endpoints were index admission mortality, postoperative complications, and 30-day readmission rates. RESULTS In total, 235 octogenarians (median age 81 (range 80-90) years) and 235 controls (age 67 (31-79) years) were included in the study. Eastern Cooperative Oncology Group performance status (median 0 (range 0-3) versus 0 (0-2); P = 0.010) and Charlson Co-morbidity Index score (7 (6-11) versus 5 (2-9); P = 0.001) were higher for octogenarians than controls. Postoperative complication and 30-day readmission rates were comparable. The 90-day mortality rate was higher among octogenarians (9 versus 3 per cent; P = 0.030). Index admission mortality rates were comparable (4 versus 2 per cent; P = 0.160), indicating that the difference in mortality was related to deaths after hospital discharge. Despite the higher 90-day mortality rate in the octogenarian population, multivariable Cox regression analysis did not identify age as an independent predictor of postoperative mortality. CONCLUSION Despite careful patient selection and comparable index admission mortality, 90-day and, particularly, out-of-hospital mortality rates were higher in octogenarians.
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Affiliation(s)
- Joseph A Attard
- Hepatopancreatobiliary and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Alexia Farrugia
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Giuseppe Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free Hospital, London, UK
| | - Simon Harper
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | | | - Asif Jah
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | - Gabriele Marangoni
- Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Michail Pizanias
- Hepatopancreatobiliary Unit, King's College Hospital, London, UK
| | | | - Keith J Roberts
- Hepatopancreatobiliary and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Chloe Sew Hee
- Hepatopancreatobiliary Unit, Cambridge University Hospital, Cambridge, UK
| | - Fiammetta Soggiu
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free Hospital, London, UK
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Zhang W, Huang Z, Zhang J, Che X. Safety and effectiveness of open pancreaticoduodenectomy in adults aged 70 or older: A meta-analysis. J Geriatr Oncol 2021; 12:1136-1145. [PMID: 33610506 DOI: 10.1016/j.jgo.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is considered the most complicated operation in abdominal surgery. The safety and effectiveness of PD in older patients has been questionable because older adults are often beset by one or more systemic diseases and have poor surgical tolerance. AIM To evaluate the safety and effectiveness of PD in patients aged 70 or older. METHODS We conducted a literature search on PubMed, EMBASE, Cochrane Library and other databases to discover all literature reporting a comparison of the efficacy of PD in patients 70 years old and older versus patients under 70 years old. Our cutoff date is August 2020. Revman5.3 statistical software was used for the analysis. RESULTS Twenty cohort studies were determined to be eligible with a total of 6508 patients; 2274 patients were 70 years old and older and 4234 patients under 70 years old. Meta-analysis results showed that after PD in patients over 70 years of age and older the mortality rate (RR = 2.1, 95%CI:1.59-2.78, p < 0.001), the overall postoperative complications (RR = 1.16,95%CI:1.09-1.23, p < 0.001), intraoperative transfusions (RR = 1.38, 95%CI:1.14-1.23, p = 0.001), severe complications (RR = 1.30,95%CI:1.11-1.52, p = 0.001), the re-operation rate (RR = 1.23,95%CI:1.00-1.51, p = 0.05), the R0 rate (RR = 0.92,95%CI:0.86-0.98, p = 0.01), lymph node dissection (WMD = -4.61,95%CI:-7.24-1.97, p < 0.001) and delayed gastric emptying (RR = 1.24,95%CI:1.04-1.49, p = 0.02) at a rate significantly higher than that of patients under 70 years old. There is no significant difference between patients 70 years old and older and patients under 70 years old in the clinical PF (RR = 1.11,95%CI:0.93-1.34, p = 0.24), bile leakage (RR = 0.68,95%CI:0.41-1.12, p = 0.13), postoperative bleeding (RR = 1,95%CI:0.76-1.30, p = 0.98), wound infection (RR = 1.15,95%CI:0.95-1.39, p = 0.15) and hospital stays (RR = 0.30,95%CI:-1.77-2.37, p = 0.77). CONCLUSION Patients aged 70 years or older have approximately double the risk of postoperative mortality following PD and a higher risk of overall and severe postoperative complications. Furthermore, patients 70 years old and older require more frequent intraoperative transfusions, re-operative interventions and have poorer oncology results (lower R0 rate and fewer lymph node dissections). More multi-center, large sample, and high-quality research is still needed to further verify this conclusion.
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Affiliation(s)
- Wei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Zhangkan Huang
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Jiangwei Zhang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Xu Che
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China; Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Eguia E, Kuo PC, Sweigert PJ, Nelson MH, Aranha GV, Abood G, Godellas C, Baker MS. The laparoscopic approach to pancreatoduodenectomy is cost neutral in very high-volume centers. Surgery 2019; 166:1027-1032. [PMID: 31472971 DOI: 10.1016/j.surg.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/19/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Little is known regarding the impact of minimally invasive approaches to pancreatoduodenectomy on the aggregate costs of care for patients undergoing pancreatoduodenectomy. METHODS We queried the Healthcare Cost and Utilization Project State Inpatient Database to identify patients undergoing elective laparoscopic or open pancreatoduodenectomy between 2014 and 2016. RESULTS In this database, 488 (10%) patients underwent elective laparoscopic; 4,544 (90%) underwent open pancreatoduodenectomy. On adjusted analysis, the risk of perioperative morbidity and overall duration of hospitalization for patients undergoing elective laparoscopic were identical to those for patients undergoing open pancreatoduodenectomy. Patients undergoing elective laparoscopic in low (+$10,399, 95% confidence interval [$3,700, $17,098]) and moderate to high (+$4,505, 95% confidence interval [$528, $8,481]) volume centers had greater costs than those undergoing open pancreatoduodenectomy in the same centers. In very high-volume centers (>127 pancreatoduodenectomies/year), aggregate costs of care for patients undergoing elective laparoscopic were essentially identical to those undergoing open pancreatoduodenectomy in the same centers (+$815, 95% confidence interval [-$1,530, $3,160]). CONCLUSION Rates of morbidity and overall duration of hospitalization for patients undergoing elective laparoscopic are not different than those undergoing open pancreatoduodenectomy. At low to moderate and high-volume centers, elective laparoscopic is associated with greater aggregate costs of care relative to open pancreatoduodenectomy. At very high-volume centers, elective laparoscopic is cost-neutral.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, IL.
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL
| | | | - Marc H Nelson
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Gerard V Aranha
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Gerard Abood
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | | | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL
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Karim SAM, Abdulla KS, Abdulkarim QH, Rahim FH. The outcomes and complications of pancreaticoduodenectomy (Whipple procedure): Cross sectional study. Int J Surg 2018; 52:383-387. [DOI: 10.1016/j.ijsu.2018.01.041] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/15/2018] [Accepted: 01/27/2018] [Indexed: 12/17/2022]
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Wang J, Ma R, Churilov L, Eleftheriou P, Nikfarjam M, Christophi C, Weinberg L. The cost of perioperative complications following pancreaticoduodenectomy: A systematic review. Pancreatology 2018; 18:208-220. [PMID: 29331217 DOI: 10.1016/j.pan.2017.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/01/2017] [Accepted: 12/18/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Pancreaticoduodenectomy (PD), also known as a Whipple procedure, is commonly performed for a variety of benign and malignant tumours, including of the pancreatic head and surrounding structures. PD is associated with low mortality but high morbidity and costs. Our objective was to describe the financial burden of complications following pancreaticoduodenectomy. METHODS We searched for articles using the MEDLINE, EMBASE, Cochrane and EconLit databases from the year 2000. Additional studies were identified by searching bibliographies. We included studies reporting on hospital cost or charge of in-hospital complications during the index PD admission. Studies including other surgeries but specifically reporting inpatient complication costs of PD were also included. Any type of PD was included. Data was collected using a data extraction table and a narrative synthesis was performed. RESULTS We identified 15 eligible articles. All included articles were retrospective studies. Acceptable evidence for increased cost due to the presence and grade of complication was found. Strong evidence demonstrated the high rate of complications. Weak evidence linked complications with specific constituents of hospital cost. Complication grade was robustly linked with increased length of stay. Not enough evidence was found to demonstrate a link between PD complications and mortality or readmissions. LIMITATIONS Included studies were heterogeneous in setting, methodology, costing data, and grading systems. CONCLUSIONS The presence and grade of PD complications increase hospital cost across diverse settings. The costing methodology should be transparent and complication grading systems should be consistent in future studies. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2017:CRD42017058427.
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Affiliation(s)
- Jason Wang
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Ronald Ma
- Department of Finance, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience & Mental Health, Parkville, VIC 3052, Australia
| | - Paul Eleftheriou
- Deputy Chief Medical Office, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Mehrdad Nikfarjam
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Christopher Christophi
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Heidelberg, VIC 3084, Australia; University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, VIC 3084, Australia.
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Kim SY, Fink MA, Perini M, Houli N, Weinberg L, Muralidharan V, Starkey G, Jones RM, Christophi C, Nikfarjam M. Age 80 years and over is not associated with increased morbidity and mortality following pancreaticoduodenectomy. ANZ J Surg 2017; 88:E445-E450. [DOI: 10.1111/ans.14039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Sandy Y. Kim
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Michael A. Fink
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Marcos Perini
- Department of Anaesthesia; Austin Health; Melbourne Victoria Australia
| | - Nezor Houli
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Laurence Weinberg
- Department of Anaesthesia; Austin Health; Melbourne Victoria Australia
| | | | - Graham Starkey
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Robert M. Jones
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Christopher Christophi
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
| | - Mehrdad Nikfarjam
- Department of Surgery; The University of Melbourne, Austin Health; Melbourne Victoria Australia
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Kim SY, Weinberg L, Christophi C, Nikfarjam M. The outcomes of pancreaticoduodenectomy in patients aged 80 or older: a systematic review and meta-analysis. HPB (Oxford) 2017; 19:475-482. [PMID: 28292633 DOI: 10.1016/j.hpb.2017.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is an increasing needed to consider pancreaticoduodenectomy (PD) for the treatment of pancreatic and periampullary malignancy in patients aged 80 and over, given the increasing aging population. METHODS A systematic literature search was undertaken to identify selected studies that compared the outcomes of patients aged 80 years or over to those younger undergoing PD. RESULTS In total 18 studies were included for evaluation. Octogenarian or older populations had significantly higher 30-day post-operative mortality rate (OR: 2.22, 95% CI = 1.48-3.31, p < 0.001) and length of hospital stay (OR: 2.23, 95% CI = 1.36-3.10, p < 0.001). The overall post-operative complication rate was higher in the older group compared to the younger population (OR: 1.51, 95% CI = 1.25-1.83, p < 0.001). Elderly patients were more likely to develop pneumonia (OR: 1.72, 95% CI = 1.39-2.13, p < 0.001) and experience delayed gastric emptying (DGE) (OR: 1.77, 95% CI = 1.35-2.31, p < 0.001). The incidence of post-operative pancreatic fistula and bile leak were not significantly different between the groups. Rehabilitation and home nursing care services was also more frequently required by the older patient group at the time of hospital discharge. CONCLUSION Patients aged 80 years and older have approximately double the risk of 30-day post-operative mortality and 50% increased rate of complications following PD. Careful patient selection is required when offering surgery in this age group.
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Affiliation(s)
- Sandy Y Kim
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher Christophi
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Mehrdad Nikfarjam
- University of Melbourne, Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.
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Adjusted Age-Adjusted Charlson Comorbidity Index Score as a Risk Measure of Perioperative Mortality before Cancer Surgery. PLoS One 2016; 11:e0148076. [PMID: 26848761 PMCID: PMC4744039 DOI: 10.1371/journal.pone.0148076] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/12/2016] [Indexed: 12/15/2022] Open
Abstract
Background Identification of patients at risk of death from cancer surgery should aid in preoperative preparation. The purpose of this study is to assess and adjust the age-adjusted Charlson comorbidity index (ACCI) to identify cancer patients with increased risk of perioperative mortality. Methods We identified 156,151 patients undergoing surgery for one of the ten common cancers between 2007 and 2011 in the Taiwan National Health Insurance Research Database. Half of the patients were randomly selected, and a multivariate logistic regression analysis was used to develop an adjusted-ACCI score for estimating the risk of 90-day mortality by variables from the original ACCI. The score was validated. The association between the score and perioperative mortality was analyzed. Results The adjusted-ACCI score yield a better discrimination on mortality after cancer surgery than the original ACCI score, with c-statics of 0.75 versus 0.71. Over 80 years of age, 70–80 years, and renal disease had the strongest impact on mortality, hazard ratios 8.40, 3.63, and 3.09 (P < 0.001), respectively. The overall 90-day mortality rates in the entire cohort varied from 0.9%, 2.9%, 7.0%, and 13.2% in four risk groups stratifying by the adjusted-ACCI score; the adjusted hazard ratio for score 4–7, 8–11, and ≥ 12 was 2.84, 6.07, and 11.17 (P < 0.001), respectively, in 90-day mortality compared to score 0–3. Conclusions The adjusted-ACCI score helps to identify patients with a higher risk of 90-day mortality after cancer surgery. It might be particularly helpful for preoperative evaluation of patients over 80 years of age.
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