Impact of patient age on outcome of minimally invasive versus open pancreatoduodenectomy: a propensity score matched study.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2024-10-18 DOI:10.1016/j.hpb.2024.10.008

Anouk M L H Emmen, Leia R Jones, Kongyuan Wei, Olivier Busch, Baiyong Shen, Giuseppe K Fusai, Yi-Ming Shyr, Igor Khatkov, Steve White, Ugo Boggi, Mustafa Kerem, I Q Molenaar, Bas G Koerkamp, Olivier Saint-Marc, Safi Dokmak, Susan van Dieren, Renzo Rozzini, Sebastiaan Festen, Rong Liu, Jin-Young Jang, Marc G Besselink, Mohammed A Hilal

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Abstract

Background: Pancreatoduodenectomy in elderly patients may be associated with increased postoperative mortality, but studies in minimally invasive pancreatoduodenectomy (MIPD) are scarce.

Methods: International multicenter retrospective study including patients aged >60 years undergoing MIPD (robot-assisted and laparoscopic) and open pancreatoduodenectomy (OPD), were categorized by age: 60-69, 70-79, and 80+ years. In each category, propensity score matching (PSM) was performed (1:1 ratio) between MIPD and OPD. Primary outcome was 30-day/in-hospital mortality.

Results: Among 3820 patients, we matched 1468 patients aged 60-69, 1154 patients aged 70-79, and 196 patients aged 80+ years. In patients aged 60-69 and 70-79 years, MIPD was associated with longer operative time, less blood loss and a longer length of stay. Major morbidity was higher after MIPD with similar 30-day/in-hospital mortality. The R0 resection rate was higher after MIPD. In patients aged 80+ years, besides a longer operative time in MIPD, outcomes were comparable between both groups.

Conclusion: This study found no evidence that increasing age worsens mortality of MIPD. MIPD was associated with longer operative time, higher rate of major morbidity, prolonged length of stay versus less blood loss and a higher R0 resection in patients aged 60-69 and 70-79 years. These differences continue in patients aged 80+ years, but became less evident.

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患者年龄对微创与开腹胰十二指肠切除术结果的影响：倾向评分匹配研究。

背景：老年患者的胰十二指肠切除术可能会增加术后死亡率：老年患者接受胰十二指肠切除术可能会增加术后死亡率，但有关微创胰十二指肠切除术（MIPD）的研究却很少：国际多中心回顾性研究包括接受微创胰十二指肠切除术（机器人辅助和腹腔镜）和开腹胰十二指肠切除术（OPD）的 60 岁以上患者，按年龄分为 60-69 岁、70-79 岁和 80 岁以上。在每个类别中，在 MIPD 和 OPD 之间进行倾向得分匹配 (PSM)（1:1 比例）。主要结果是30天/住院死亡率：在 3820 名患者中，我们匹配了 1468 名 60-69 岁患者、1154 名 70-79 岁患者和 196 名 80 岁以上患者。在 60-69 岁和 70-79 岁的患者中，MIPD 与手术时间长、失血少和住院时间长相关。MIPD术后主要发病率较高，但30天/住院死亡率相似。MIPD术后的R0切除率更高。在80岁以上的患者中，除了MIPD的手术时间更长外，两组患者的治疗效果相当：结论：本研究没有发现任何证据表明，年龄的增加会降低MIPD的死亡率。在 60-69 岁和 70-79 岁的患者中，MIPD 与较长的手术时间、较高的主要发病率、较长的住院时间和较少的失血以及较高的 R0 切除率相关。这些差异在 80 岁以上的患者中继续存在，但变得不那么明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).