Visceral medicine · 2026
Outcomes following Pancreatoduodenectomy in Patients ≥80 Years: An Analysis of the Prospective Pancreas Registry of the German Society for General and Visceral Surgery (DGAV|Registry Pancreas).
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Scherber Philipp, Holländer Sebastian, Gäbelein Gereon, Igna Dorian, Jacob Peter, Pascher Andreas, Ghadimi Michael, Reissfelder Christoph, Fichtner-Feigl Stefan, Ritz Jörg-Peter, Keck Tobias, Uhl Waldemar, Klinger Carsten, Buhr Heinz, Kalff Jörg C, Werner Jens, Glanemann Matthias
Аннотация
INTRODUCTION: With rising life expectancy, the number of elderly patients undergoing pancreatoduodenectomy is steadily increasing. This study aimed to assess peri- and postoperative outcomes in patients aged ≥ 80 years undergoing pancreatoduodenectomy, using data from the DGAV|registry pancreas.
METHODS: All pancreatoduodenectomies performed between September 2013 and April 2024 and recorded in the DGAV|registry pancreas were retrospectively analyzed. Patients were divided into two groups: <80 and ≥80 years. Demographic, perioperative, and postoperative data were compared. A multivariate analysis was conducted to identify independent risk factors for in-hospital mortality.
RESULTS: Out of 12,305 pancreatoduodenectomies, 1,566 (12.7%) were performed in patients aged ≥ 80 years. The proportion of very elderly patients more than doubled from 6.9% in 2014 to a peak of 17.3% in 2021. Malignant diseases, particularly pancreatic ductal adenocarcinoma, were more common in this group. While overall complication rates were slightly higher in the elderly (64.0% vs. 60.7%, p = 0.013), there was no significant difference in severe complications (Clavien-Dindo grades 3 and 4). However, 30-day mortality (7.2% vs. 3.6%) and in-hospital mortality (8.2% vs. 4.4%) were significantly higher in patients aged ≥ 80 years. Cardiopulmonary complications were also more frequent. Multivariate analysis identified age ≥ 80, male sex, ASA class 3 or 4, obesity, COPD, anticoagulant therapy, the need for intraoperative blood transfusions, and extended resections as independent predictors of in-hospital mortality.
CONCLUSION: Chronological age ≥ 80 years is associated with increased postoperative morbidity and mortality after pancreatoduodenectomy. However, age alone should not be considered an exclusion criterion. Careful patient selection, taking biological age, comorbidities, and functional status into account, is essential. Integrating geriatric expertise and prehabilitation strategies may improve outcomes in this growing patient population.
METHODS: All pancreatoduodenectomies performed between September 2013 and April 2024 and recorded in the DGAV|registry pancreas were retrospectively analyzed. Patients were divided into two groups: <80 and ≥80 years. Demographic, perioperative, and postoperative data were compared. A multivariate analysis was conducted to identify independent risk factors for in-hospital mortality.
RESULTS: Out of 12,305 pancreatoduodenectomies, 1,566 (12.7%) were performed in patients aged ≥ 80 years. The proportion of very elderly patients more than doubled from 6.9% in 2014 to a peak of 17.3% in 2021. Malignant diseases, particularly pancreatic ductal adenocarcinoma, were more common in this group. While overall complication rates were slightly higher in the elderly (64.0% vs. 60.7%, p = 0.013), there was no significant difference in severe complications (Clavien-Dindo grades 3 and 4). However, 30-day mortality (7.2% vs. 3.6%) and in-hospital mortality (8.2% vs. 4.4%) were significantly higher in patients aged ≥ 80 years. Cardiopulmonary complications were also more frequent. Multivariate analysis identified age ≥ 80, male sex, ASA class 3 or 4, obesity, COPD, anticoagulant therapy, the need for intraoperative blood transfusions, and extended resections as independent predictors of in-hospital mortality.
CONCLUSION: Chronological age ≥ 80 years is associated with increased postoperative morbidity and mortality after pancreatoduodenectomy. However, age alone should not be considered an exclusion criterion. Careful patient selection, taking biological age, comorbidities, and functional status into account, is essential. Integrating geriatric expertise and prehabilitation strategies may improve outcomes in this growing patient population.