Surgical outcomes of laparoscopic distal pancreatectomy in elderly and octogenarian patients: a single-center, comparative study
- 68 Downloads
Although recent reports have suggested the advantages of laparoscopic distal pancreatectomy (LDP), the potential benefits of this approach in elderly patients remain unclear. The aim of this study was to clarify the value of LDP in the elderly, in whom co-morbid diseases were generally more common.
Seventy elderly patients (≥ 70 years) and 264 non-elderly patients (40–69 years) who underwent LDP, and 48 elderly patients (≥ 70 years) who underwent open distal pancreatectomy (ODP) between May 2005 and May 2018 were studied. Demographics, intraoperative, and postoperative outcomes were compared.
Comorbidity was more common in elderly patients than in non-elderly patients who underwent LDP (57.1 vs. 38.3%, p < 0.01). The intraoperative factors, postoperative complication rate, and length of hospital stay were comparable in these two groups. Elderly patients who underwent LDP had a significantly shorter operative time (185.5 vs. 208.0 min, p = 0.02), less blood loss (191.0 vs. 291.8 mL, p < 0.01), and reduced length of postoperative hospital stay (11.4 vs. 15.1 days, p < 0.01) than elderly patients who had ODP. The overall complication rate tended to be lower in LDP group than that in ODP group (20.0 vs. 33.3%, p = 0.07).
LDP performed on the elderly is safe and feasible, leading to short-term outcomes similar to those of non-elderly patients. LDP could be an alternative to ODP in elderly patients, providing a lower rate of morbidity and favorable postoperative recovery and outcomes.
KeywordsLaparoscopy Pancreatectomy Elderly Adenocarcinoma Morbidity
Laparoscopic distal pancreatectomy
Open distal pancreatectomy
Postoperative pancreatic fistula
International Study Group on Pancreatic Fistula
Pancreatic duct adenocarcinoma
Retrieved lymph nodes
Body mass index
American society of anesthesiologists
Intraductal papillary mucinous neoplasm
Solid pseudopapillary tumor
Compliance with ethical standards
Ke Chen, Yu Pan, Yi-ping Mou, Jia-fei Yan, Ren-chao Zhang, Miao-zun Zhang, Jia-yu Zhou, Xian-fa Wang, Hendi Maher, and Qi-long Chen have no conflicts of interest or financial ties to disclose.
- 8.Sulpice L, Farges O, Goutte N, Bendersky N, Dokmak S, Sauvanet A, Delpero JR (2015) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: time for a randomized controlled trial? results of an all-inclusive national observational study. Ann Surg 262(5):868–873CrossRefGoogle Scholar
- 10.Giuliani A, Ceccarelli G, Rocca A (2018) The role of laparoscopic distal pancreatectomy in elderly patients. Minerva Chir 73(2):179–187Google Scholar
- 16.Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591CrossRefGoogle Scholar
- 20.Zhang M, Fang R, Mou Y, Chen R, Xu X, Zhang R, Yan J, Jin W, Ajoodhea H (2015) LDP vs ODP for pancreatic adenocarcinoma: a case matched study from a single-institution. BMC Gastroenterol 15(182):015–0411Google Scholar
- 21.Martinez-Cecilia D, Cipriani F, Vishal S, Ratti F, Tranchart H, Barkhatov L, Tomassini F, Montalti R, Halls M, Troisi RI, Dagher I, Aldrighetti L, Edwin B, Abu Hilal M (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265(6):1192–1200CrossRefGoogle Scholar
- 25.Sahakyan MA, Kazaryan AM, Rawashdeh M, Fuks D, Shmavonyan M, Haugvik SP, Labori KJ, Buanes T, Rosok BI, Ignjatovic D, Abu Hilal M, Gayet B, Kim SC, Edwin B (2016) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endosc 30(8):3409–3418CrossRefGoogle Scholar
- 34.Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785CrossRefGoogle Scholar
- 36.Sun Z, Zhu Y, Zhang N (2015) The detail of the en bloc technique and prognosis of spleen-preserving laparoscopic distal pancreatectomy for pancreatic cancer. World J Surg Oncol 13(322):015–0735Google Scholar