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Authors Lu Q, Lu JW, Wu Z, Liu XM, Li JH, Dong J, Yin GZ, Lv Y, Zhang XF
Received 2 October 2017
Accepted for publication 16 December 2017
Published 24 January 2018 Volume 2018:13 Pages 133—141
DOI https://doi.org/10.2147/CIA.S153058
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Wu
Objective: The aim of this study was to determine the safety of elderly cancer
patients (≥70 years) undergoing hepatic resection (HR) or
pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years).
Methods: A total of 1,012 consecutive patients undergoing
HR or PD were included. The incidence and severity of morbidity were documented
within 30 days postoperatively and compared between elderly and younger groups.
Risk factors associated with postoperative morbidity were investigated by
multivariate logistic regression analysis.
Results: Elderly patients (n=111, 11.0%) had more
comorbidities and worse preoperative general condition and liver function
versus younger patients (n=901, 89.0%), and thus were more likely to develop
infectious (eg, systemic sepsis and urinary tract infection, both p <0.01) and
technical-associated complications (intraperitoneal bleeding and
biliary/pancreatic fistula, p =0.029 and p =0.074, respectively). However,
the incidence and severity of complications were comparable between elderly and
younger patients in the whole cohort, and also in HR and PD surgery groups
separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p =0.007) and intraoperative blood
transfusion (OR 1.9, p =0.002), rather
than age, were independently associated with postoperative morbidity. Hepatitis
(OR 2.9, p =0.001), preoperative hemoglobin
(OR 1.6, p =0.036), and pancreatic
versus hepatic surgery (OR 2.3, p =0.005) were
independently associated with postoperative infectious. For elderly patients
only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p =0.033) and intraoperative blood
transfusion (OR 3.2, p =0.030) were
independently associated with postoperative morbidity.
Conclusion: HR and PD can be safely performed in selected
elderly patients versus younger patients. Elderly patients with ASA score III
or above should be cautiously selected for major surgeries.
Keywords: morbidity,
elderly, hepatectomy, pancreaticoduodenectomy