Safety And Feasibility Of Laparoscopic Pancreaticoduodenectomy In Patients Aged 70 Years Old And Over

Objective To explore the safety and feasibility of laparoscopic pancreaticoduodenectomy(LPD)in senile patients.Methods Retrospective analysis was used to the clinical data of patients undergoing LPDfrom September 2012 to December 2018.Patients aged 70 years old and over were in senile group,while patients aged less than 70 years old were in non-senile group.We compared theperioperative data,such as the preoperativegeneral information,surgery related indicators,incidences of postoperative complication as well as hospital stay between two groups.Results From September 2012 to December 2018,a total of 509 cases of LPD were completed,including 132 cases in senile group and 377 cases in non-senile group.There were statistical differences in the comorbidity of cardiopulmonary disease and score of American Society of Anesthesiologists(ASA)between two groups before surgery(P<0.05).After surgery,the incidences of cardiac and pulmonary complication in senile group were higher than those in non-senile group respectively with statistical differences(14.3% vs 2.4%,P<0.05;6% vs 1.3,P<0.001).Besides,the rate of admission to Intensive Care Unit(ICU)of senile group was higher than that of non-senile group with a statistical difference(34% vs 10%,P<0.01);the postoperative hospital stay of senile group was longer than that of non-senile group also with a statistical difference [(19.2 ± 11.9)days vs(16.7 ± 7.1)days,P = 0.01].However,there were no statistical differences in the operation time,blood transfusion rate,operation methods andintraoperativeblood loss between groups(P> 0.05).There were also no statistical differences in the main complications,such as the pancreatic leakage,bile leakage,abdominal infection and hemorrhage between two groups(P>0.05).In perioperative period,there was one case death in senile group and two cases death in non-senile group with no statistical difference.Conclusion Although senile patientsaged 70 years old and over have high incidences ofpostoperative cardiopulmonary complication,a high rate of admission to ICU after LPD and long postoperative hospital stay,the incidence of overall complicationsand mortality have not increased significantly.It is safe and feasible for medical centers with mature LPD technology and conditionsfor close monitoring to carry out LPD in senile patients.