Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery.
Objective
The aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years).


Methods
A total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis.


Results
Elderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p<0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p=0.029 and p=0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p=0.001), preoperative hemoglobin (OR 1.6, p=0.036), and pancreatic versus hepatic surgery (OR 2.3, p=0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p=0.033) and intraoperative blood transfusion (OR 3.2, p=0.030) were independently associated with postoperative morbidity.


Conclusion
HR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries.
['Lu|Qiang|Q|', 'Lu|Jian-Wen|JW|', 'Wu|Zheng|Z|', 'Liu|Xue-Min|XM|', 'Li|Jian-Hui|JH|', 'Dong|Jian|J|', 'Yin|Guo-Zhi|GZ|', 'Lv|Yi|Y|', 'Zhang|Xu-Feng|XF|']
D000328:Adult D000367:Age Factors D000368:Aged D001803:Blood Transfusion D015331:Cohort Studies D005260:Female D006498:Hepatectomy D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D016017:Odds Ratio D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D016896:Treatment Outcome
elderly pancreaticoduodenectomy morbidity hepatectomy