Outcomes Following Pancreatoduodenectomy in Octogenarians in Scotland

Abstract

Background: The benefit of pancreatoduodenectomy (PD) in patients over 80 is not well established. The outcomes of patients undergoing PD in Scotland over a ten year period were evaluated to determine efficacy of this procedure in elderly patients. Methods: Data from all patients who had undergone PD in Scotland from 2007-2017 were collated. Primary outcome was overall survival and secondary outcomes included post-operative morbidity, mortality rates and rates of procedure specific morbidity – post-operative pancreatic fistula (POPF), delayed gastric emptying (DGE) and post-procedure haemorrhage (PPH). Outcomes for those over 80 years were compared with patients under 80. Results: 1102 patients underwent PD during the study period of which 30 (2.7%) were over 80. Overall survival for over 80s was 18.7 months compared with 33 months for under 80s (p=0.002). For patients over 80 with pancreatic adenocarcinoma, median survival was 12.5 months compared with 21 months for those under 80 (p=0.06). There was no significant difference in length of stay - 15 days (over 80s) versus 14 days (under 80s) p=0.85; major morbidity - 10% (over 80s) versus 16.4% (under 80s) p=0.2; and 90 day mortality - 10% (over 80s) versus 6.4% (under 80s) p=0.44. No significant difference was observed in rates of POPF, PPH or DGE. Conclusions: Low numbers of patients over 80 in Scotland undergo PD and overall survival is reduced in this group. Short term outcomes in patients over 80 are comparable to younger patients however, and access to surgery in this group could potentially be improved by prehabilitation.