Minimally invasive pancreatectomies and hepatectomies for the elderly. Safety and outcomes

Abstract

Presenter: Elizabeth De La Rosa | Texas Tech University Health Sciences Center Background: Minimally invasive pancreatectomies and hepatectomies are gaining popularity. Their outcomes in the elderly are not established. We hypothesized that with the increased use of minimally invasive surgery (MIS) for pancreas and liver surgery perioperative outcomes are maintained in the elderly (≥80yo). Methods: The National Cancer Database (2010-2016) was utilized to assess perioperative outcomes of minimally invasive pancreatectomies and hepatectomies. Results: Data from 45375 pancreatectomies and 10526 hepatectomies were analyzed. Median age was 66 for the pancreatectomies (range:18-90) and 64 for the hepatectomies (range:18-90) whereas 8.9% of patients who underwent pancreatectomy and 6.3% of patients who underwent hepatectomy were ≥80yo. The utilization of MIS surgery for patients ≥80yo increased from 2010 to 2016 (for pancreatectomies: robotic: increase from 1.4% to 8%; laparoscopic: increase from 14.1% to 23.6%; hepatectomies: robotic: increase from 0.9% to 4.3%, laparoscopic: increase from 18.8% to 26.4%). Most common MIS pancreatectomies were partial pancreatectomies/distals (42%) and Whipples (29%) whereas MIS hepatectomies were partial lobectomies (69%). MIS pancreatectomies and hepatectomies for the elderly had lower 90 day mortality rates compared to open which reached significance for pancreatectomies (pancreatectomies MIS: 8 vs 13.3%; p<0.001; hepatectomies MIS 8.9% vs 11.3%; p=0.3). The Charlson Comorbidity Index (CCI) didn’t correlate with 90 day mortality for the elderly who underwent MIS surgery (pancreatectomies: mortality 12.6%, 11.1%, 8.6% and 13% for CCI scores 0,1,2,3; hepatectomies: mortality 4.7%, 12.8%, 11.1%, 21.4% for CCI scores 0,1,2,3; p=0.1). Conclusion: With appropriate patient selection there is increase utilization of minimally invasive pancreatectomies and hepatectomies for the elderly with improved outcomes compared to open surgery. Elderly patients should not be excluded from clinical trials on minimally invasive surgery. The development of preoperative comprehensive geriatric assessment tools more sensitive than comorbidity indexes may allow for better patient selection for minimally invasive surgery.