Treatment And Analysis Of Preoperative Coexisting Diseases And Postoperative Complications In Elderly Patients With Pancreaticoduodenectomy

BackgroundAs the most complex surgery of general surgery,Pancreaticoduodenectomy(PD) has now become the ampulla around malignant tumors and standard operation procedure for benign disease,since the introduction and promotion by Allen Whipple at 1935.With the improvement of the surgical technique,operative methods and the strengthening of perioperative treatment, postoperative mortality of pancreaticoduodenal resection has fallen to less than 5%, However, because of involving many organs, big trauma, and long operation time of PD surgery, incidence of postoperative complications is still as high as 30%-50%.Its major surgical coexisting diseases such as pancreatic fistula, abdominal bleeding, biliary fistula, gastric paralysis, abdominal infection, gastrointestinal (GI) fistula, etc, all Continuation of a long time and have a considerable chance of death. Therefore, patients need a higher surgical tolerance. With the extension of human life expectancy and the aging society, the demand for PD surgery in elderly patients is increasing year by year,Due to the elderly tumor patients is often associated with a variety of underlying diseases, heart, lung, kidney and liver functions have a certain degree of loss, decreased the tolerance of coexisting diseases after surgery and so for elderly patients should give PD surgical treatment is still debated.ObjectiveTo determine the safety of PD for elderly patients,Retrospective analysis of clinical data of elderly patients with PD, give a comparative study of clinical data of patients with general PD,to analyze the difference of preoperative coexisting diseases of the two groups and its influence to Postoperative morbidity and mortality and to explore the perioperative treatment.Materials and MethodsRetrospective analysis of 33 cases of elderly patients with PD and 31 cases of general PD in Qilu Hospital from August 2004 to August 2014,dividing into elderly group (over 70 years old, n=33) and young group (< 70, n=31),comparing the incidence of Preoperative coexisting diseases and postoperative complications and mortality between the two groups.Using SPSS19.0 for analysis, counting data for chi square test, because the data is small, according to the exact probability method for analysis. P< 0.05 for the difference has statistical significance.ResultsThe preoperative coexisting diseases (mainly associated with heart and lung disease and hypoproteinemia) of age group was significantly higher than that in the younger group (69.7%vs38.7%, P=0.023).There was no significant difference in the incidence of postoperative complications (54.5%vs54.8%, P=1.000) and mortality (12.1%vs12.9%, P=1.000) between the two groups (P>0.05).ConclusionElderly patients with preoperative coexist disease incidence rate was higher than that in younger patients, but the incidence of postoperative complications and mortality did not differ significantly.Preoperative treatment of comorbid diseases and assess the risk of surgery, intraoperative fine operation, postoperative active prevention and treatment of coexisting diseases, the elderly patients with pancreaticoduodenectomy is safe and feasible.