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Quero G, Pecorelli N, Paiella S, et al. Pancreaticoduodenectomy in octogenarians: The importance of "biological age" on clinical outcomes. Surg Oncol. 2021;40:101688doi: 10.1016/j.suronc.2021.101688.
Quero, G., Pecorelli, N., Paiella, S., Fiorillo, C., Petrone, M. C., Capretti, G., Laterza, V., De Sio, D., Menghi, R., Kauffmann, E., Nobile, S., Butturini, G., Ferrari, G., Rosa, F., Coratti, A., Casadei, R., Mazzaferro, V., Boggi, U., Zerbi, A., Salvia, R., Falconi, M., & Alfieri, S. (2021). Pancreaticoduodenectomy in octogenarians: The importance of "biological age" on clinical outcomes. Surgical oncology, 40101688. https://doi.org/10.1016/j.suronc.2021.101688
Quero, Giuseppe, et al. "Pancreaticoduodenectomy in octogenarians: The importance of "biological age" on clinical outcomes." Surgical oncology vol. 40 (2021): 101688. doi: https://doi.org/10.1016/j.suronc.2021.101688
Quero G, Pecorelli N, Paiella S, Fiorillo C, Petrone MC, Capretti G, Laterza V, De Sio D, Menghi R, Kauffmann E, Nobile S, Butturini G, Ferrari G, Rosa F, Coratti A, Casadei R, Mazzaferro V, Boggi U, Zerbi A, Salvia R, Falconi M, Alfieri S. Pancreaticoduodenectomy in octogenarians: The importance of "biological age" on clinical outcomes. Surg Oncol. 2021 Nov 24;40:101688. doi: 10.1016/j.suronc.2021.101688. Epub 2021 Nov 24. PMID: 34844071.
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Surg Oncol. 2021 Nov 24;40:101688. doi: 10.1016/j.suronc.2021.101688. Epub 2021 Nov 24.

Pancreaticoduodenectomy in octogenarians: The importance of "biological age" on clinical outcomes.

Surgical oncology

Giuseppe Quero, Nicolò Pecorelli, Salvatore Paiella, Claudio Fiorillo, Maria Chiara Petrone, Giovanni Capretti, Vito Laterza, Davide De Sio, Roberta Menghi, Emanuele Kauffmann, Sara Nobile, Giovanni Butturini, Giovanni Ferrari, Fausto Rosa, Andrea Coratti, Riccardo Casadei, Vincenzo Mazzaferro, Ugo Boggi, Alessandro Zerbi, Roberto Salvia, Massimo Falconi, Sergio Alfieri

Affiliations

  1. Gemelli Pancreatic Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Largo Agostino Gemelli, 8, 00168, Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168, Rome, Italy.
  2. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Pancreato-Biliary Endoscopy and EUS Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  3. Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy.
  4. Gemelli Pancreatic Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Largo Agostino Gemelli, 8, 00168, Rome, Italy. Electronic address: [email protected].
  5. Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
  6. Gemelli Pancreatic Center, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Largo Agostino Gemelli, 8, 00168, Rome, Italy.
  7. Chirurgia Generale Universitaria dell'Ospedale di Cisanello, Via Paradisa, 2, 56124, Pisa, Italy.
  8. Casa di Cura Pederzoli, Via Monte Baldo 24, 37019, Peschiera del Garda, Verona, Italy.
  9. ASST Grande Ospedale Metropolitano Niguarda, Division of Minimally-invasive Surgical Oncology, Piazza Ospedale Maggiore, 3 20162, Milan, Italy.
  10. Division of Surgical Oncology and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy.
  11. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
  12. HPB Surgery and Liver Transplantation, Department of Oncology, University of Milan, Milan, Italy; Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy.

PMID: 34844071 DOI: 10.1016/j.suronc.2021.101688

Abstract

INTRODUCTION: With the prolongation of life expectancy, an increasing number of elderly patients are evaluated for pancreatic surgery. However, the influence of increasing age on outcomes after pancreaticoduodenectomy (PD) is still unclear, especially in octogenarians. Aim of this study is to evaluate the perioperative characteristics and outcomes of octogenarians undergoing PD.

METHODS: Data for 812 patients undergoing PD between 2019 and 2020 in 10 referral centers in Italy were reviewed. Patients aged 80 years or older were matched based on nearest neighbor propensity scores in a 1:1 ratio to patients younger than 80 years. Propensity scores were calculated using 7 perioperative variables including gender, ASA score, neoadjuvant treatment (NAT), biliary stent positioning, type of surgical approach (open, laparoscopic, robot-assisted), associated vascular resections, type of lesion. Perioperative characteristics and short-term postoperative outcomes were compared before and after matching.

RESULTS: Overall, 81 (10%) patients had 80 years or more. Before matching, octogenarians had a higher rate of ASA score≥ 3 (n = 35, 43.2% vs. n = 207, 28.3%; p = 0.005) and less frequently underwent NAT (n = 11, 13.6% vs. n = 213, 29.1%; p = 0.003). Matching was successfully performed for 70 octogenarians. After matching, no differences in preoperative and intraoperative characteristics were found. Postoperatively, ICU admission was more frequent in octogenarians (50% vs 30%; p = 0.01). Although in-hospital mortality was higher in octogenarians before matching (7.4% vs 2.9% in the younger cohort; p = 0.03), no difference was noted between the matched cohorts (p = 0.36). Postoperative morbidity was comparable between groups in the whole and selected populations. At the multivariate analysis, chronological age was not recognized as a prognostic factor for cumulative major complications, while ASA ≥3 was the only confirmed influencing feature (OR 2.98; 95%CI: 1.6-6.8; p = 0.009).

CONCLUSIO: In high-volume centers, PD in octogenarians shows similar outcomes than younger patients. Age itself should not be considered an exclusion criterion for PD, but a focused preoperative assessment is essential for adequate patient selection.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Keywords: Aging; Elderly; Pancreatic cancer; Pancreatic surgery; Pancreaticoduodenectomy

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