Pancreaticoduodenectomy in the very elderly
Pancreaticoduodenectomy in the very elderly
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DOI：
10.1016/j.gassur.2005.12.014
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发表时间：
2006-03-01
影响因子：
3.2
通讯作者：
Yeo, CJ
中科院分区：
文献类型：
--
作者：
Makary, MA;Winter, JM;Yeo, CJ
据估计，到 2050 年，老年人口（≥ 65 岁）将增加 300%，接受手术评估的老年患者也会相应增加。该人群的手术决策可能很困难，因为老年人的结果很难确定。我们回顾了我们机构在 35 年期间（1970 年 4 月至 2005 年 3 月）连续进行的 2698 例胰十二指肠切除术 (PD)，其中最后 1000 例切除术是在过去 4 年中完成的。收集的数据包括手术指征、死亡率（定义为 30 天或院内死亡率）、并发症和生存率。患者按年龄分为三组（< 80 岁、80-89 岁和 >= 90 岁），并使用多元逻辑回归进行评估。 207 名 80 岁以上的患者接受了 PD（2698 名患者中的 7.7%）。 80-89岁患者的死亡率为4.1%（197名患者中的8名），并发症率为52.8%（197名患者中的99名），而90岁患者的并发症率为50%（10名患者中的5名）。 80-89岁患者的一年生存率为59.1%，≥90岁患者的一年生存率为60%。调整术前合并症后，年龄并不是 PD 围手术期死亡率和发病率的独立危险因素。我们证明 PD 可以在 80 岁以上的患者中安全地进行，并得出结论，年龄不应单独成为胰腺切除术的禁忌症。手术效果改善和人口老龄化的出现可能会导致未来几十年内进行腹膜透析的数量显着增加。
It is estimated that by 2050, there will be a 300% increase in the elderly population (>= 65 years) and a corresponding increase in elderly patients presenting for surgical evaluation. Surgical decision-making in this population can be difficult because outcomes in the elderly are poorly defined. We reviewed 2698 consecutive pancreaticoduodenectomies (PDs) at our institution over a 35-year period (April 1970 through March 2005), with the last 1000 resections being done in the last 4 years. Data collected included surgical indication, mortality (defined as 30-day or in-hospital mortality), complications, and survival. Patients were divided by age into three groups (< 80, 80-89, and >= 90 years) and evaluated using multiple logistic regression. Two hundred seven patients >= 80 years old underwent a PD (7.7% of 2698). Patients 80-89 years of age had a mortality rate of 4.1% (8 of 197) and a complication rate of 52.8% (99 of 197), whereas patients = 90 years of age, and their complication rate was 50% (5 of 10). One-year survival for patients 80-89 years of age was 59.1%, and that for patients >= 90 Years was 60%. Age was not an independent risk factor for perioperative mortality and morbidity following PD after adjusting for preoperative comorbidities. We demonstrate that PD can be safely performed in patients over 80 years of age and conclude that age alone should not be a contraindication to pancreatic resection. The advent of improved surgical outcomes and an aging population will likely result in a significant increase in the number of PDs performed in the next few decades.