Nutritional assessment and surgical outcomes in patients aged 80 years and older undergoing pancreaticoduodenectomy

Abstract

Background: Conflicting data exist regarding the safety of Pancreaticoduodenectomy (PD) in elderly patients. This study aimed to evaluate and compare nutritional factors and clinical outcomes of PD between elderly and non-elderly patients. Methods: A retrospective study was conducted among 116 consecutive patients who underwent PD from April 2008 to August 2019. We compared pre- and post-operative nutritional factors (prognostic nutritional index [PNI], controlling nutritional status [CONUT] score), complication rates, and survival rates between the elderly (age ≥80 years) and non-elderly (age < 80 years) patient groups. Results: Nineteen elderly patients (18.4%) and 97 non-elderly patients (83.6%) underwent PD. Among preoperative factors, elderly patients had significantly lower PNI and higher CONUT scores than non-elderly patients. The duration of operation and amount of blood loss were similar between the two groups. Three-months post-operation, elderly patients had lower albumin levels and PNI than non-elderly patients. The post-operative complication rates and the incidence rate of pancreatic fistula were similar between the two groups. Median length of hospital stay was significantly longer in elderly patients (41 days) than in non-elderly patients (27 days). The rate of death due to other diseases was relatively higher in elderly patients than in non-elderly patients. Elderly patients had significantly lower overall survival rates than non-elderly patients (1-/3-/5-year overall survival; 83.4/49.7/14.2% vs. 87.1/54.1/47.3%; log-rank test, P=0.008). Conclusion: Elderly patients had lower nutritional status and lower survival rates than non-elderly patients. Careful patient selection and optimal peri-operative care are necessary for determining whether PD is indicated in elderly patients.