Short-term outcomes after minimally invasive versus open pancreaticoduodenectomy in elderly patients: a propensity score-matched analysis

Yu-Yin Liu,Yueh-Wei Liu,Shih-Min Yin,Chih-Chi Wang,Wei-Feng Li,Cheng-Hsi Yeh,Chee-Chien Yong

doi:10.1186/s12893-021-01052-2

Yu-Yin Liu, Yueh-Wei Liu + Show 5 more

Open Access

https://doi.org/10.1186/s12893-021-01052-2

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Abstract

BackgroundTo date, the evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy. This study aim to compare the risk and benefit between MIPD and open pancreatoduodenectomy (OPD) in elderly patients.MethodsFrom 2016 to 2020, we retrospective enrolled 26 patients underwent MIPD and other 119 patients underwent OPD. We firstly compared the baseline characteristics, 90-day mortality and short-term surgical outcomes of MIPD and OPD. Propensity score matching was applied for old age patient (≥ 65-year-old vs. < 65-year-old) for detail safety and feasibility analysis.ResultsPatients received MIPD is significantly older, had poor performance status, less lymph node harvest, longer operation time, less postoperative hospital stay (POHS) and earlier drain removal. After 1:2 propensity score matching analysis, elderly patients in MIPD group had significantly poor performance status (P = 0.042) compared to OPD group. Patients receiving MIPD had significantly shorter POHS (18 vs. 25 days, P = 0.028), earlier drain removal (16 vs. 21 days, P = 0.012) and smaller delay gastric empty rate (5.9 vs. 32.4% P = 0.036). There was no 90-day mortality (0% vs. 11.8%, P = 0.186) and pulmonary complications (0% vs. 17.6%, P = 0.075) in MIPD group, and the major complication rate is comparable to OPD group (17.6% vs. 29.4%, P = 0.290).ConclusionFor elderly patients, MIPD is a feasible and safe option even in patients with inferior preoperative performance status. MIPD might also provide potential advantage for elderly patients in minimizing pulmonary complication and overall mortality over OPD.

Highlights

To date, the evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy
Out of the total 145 patients included in this retrospective series, 119 patients were in the open pan‐ creatoduodenectomy (OPD) group, and 26 patients were in the MIPD group
propensity score-matching (PSM) propensity score matching, MIPD minimal invasive pancreatoduodenectomy, OPD open pancreatoduodenectomy, CCI Charlson comorbidity index, ASA score American Society of Anesthesiologists classification score, ECOG Eastern Cooperative Oncology Group studies have reported that MIPD enabled early recovery, reduced postoperative pain and the need for analgesic injections and shortened the duration of postoperative hospital stay (POHS) [28,29,30]

Summary

Introduction

The evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy. This study aim to compare the risk and benefit between MIPD and open pan‐ creatoduodenectomy (OPD) in elderly patients. Yin et al BMC Surg (2021) 21:60 periampullary malignancy It is one of the most challenging and complex surgeries due to requirement of numerous reconstructions and the presence of anatomical variations. Several studies have reported on the safety and feasibility of open pancreaticoduodenectomy (OPD) in elderly patients without significant increase in the mortality and morbidity [9, 10], the risk for major complication and prolong postoperative recovery is still remain great concern. Recent studies have reported more number of major post-pancreatectomy complications [11], and significantly higher 30-day and 60-day mortality in elderly patients [12, 13]

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