Is age just a number or a serious consideration for outcomes after pancreaticoduodenectomy in a developing country?

Abstract

Background: The effect of age on outcomes after pancreaticoduodenectomy has been reported inconsistently. The objective of our study was to review the impact of age on perioperative and oncological outcomes in patients following pancreaticoduodenectomy. Methods: All patients who underwent pancreaticoduodenectomy from January 2014 to December 2018 at Shaukat Khanum Memorial Cancer Hospital and Research Center were reviewed. Postoperative morbidity and oncological outcomes were compared between patients with age ≤ 60 years (Group A) and age > 60 years (Group B). Results: A total of 161 patients underwent pancreaticoduodenectomy during the study period including 117 (73%) in group A and 44 (27%) in group B. Mean age was 46±11 years in group A and 67±5 years in group B. Most common pathology was adenocarcinoma (81%), commonest site was periampullary (53%) and most common pancreatic reconstruction technique was pancreaticogastrostomy (68%). Patients in group B had significantly higher comorbidities including hypertension (p=0.00) and ischemic heart disease (p=0.030). There was no significant difference in morbidity (p=0.856), reoperation (p= 1.000) and 30-day readmission rate (p=0.097) betweenthe two groups. Similarly, there was no difference in disease free survival (p=0.957) and overall survival (p=0.070) in both groups. On multivariate analysis, soft pancreas (p=0.00) and non-dilated pancreatic duct (p=0.00) were associated with postoperative complications while ECOG performance status and ASA score did not show significant association. Conclusion: Pancreaticoduodenectomy can be performed in elderly patients with comparable morbidity and oncological outcomes as younger patients. Comorbid conditions remain higher in elderly patients and preoperative optimization can prevent worse postoperative outcomes.