Abstract
Background
Surgery is the only effective treatment strategy for a symptomatic pharyngeal pouch. However, octo- and nonagenarians are often denied referral to a surgeon because of perceived increased risks. Here, we compare the outcomes of pharyngeal pouch surgery in octo- and nonagenarians with patients under 80 years-of-age and determine the factors which predict post-operative complications and improvement in swallowing.
Methods
Analysis of a prospectively maintained database of patients who underwent pharyngeal pouch surgery across seven hospitals over 15 years.
Results
In total, 113 patients (≥80 years-of-age: 27, <80 years-of-age: 86) underwent endoscopic or open pharyngeal pouch surgery. Despite more comorbidities and a longer hospital stay (median: one extra day), patients ≥80 years-of-age had comparable operative time, complication profile, intensive care admission, emergency reoperation, and revisional pouch surgery as their younger counterparts. Furthermore, the severity of complications was not significantly different between the two age cohorts. No surgical mortality was recorded. Multivariate analysis demonstrated that diverticulectomy combined with cricopharyngeal myotomy independently predicted higher rates of complications (OR: 4.53, 95% CI: 1.43–14.33, p = 0.010), but also greater symptomatic improvement (OR: 4.36, 95% CI: 1.50–12.67, p = 0.007). Importantly, a greater proportion of octo- and nonagenarians experienced improved swallowing than patients <80 years-of-age (96.3% vs. 74.4%, p = 0.013). Moreover, advanced age was not predictive of post-operative complications on multivariate analysis.
Conclusions
Pharyngeal pouch surgery in octo- and nonagenarians is safe and effective. Surgical correction in this age group alleviates symptoms and improves quality-of-life for most patients. These patients should not be denied surgery on the basis of advanced age alone.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Siddiq MA, Sood S, Strachan D (2001) Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J 77:506–511
Crescenzo DG, Trastek VF, Allen MS et al (1998) Zenker’s diverticulum in the elderly: is operation justified? Ann Thorac Surg 66:347–350
Feeley MA, Righi PD, Weisberger EC et al (1999) Zenker’s diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy. Laryngoscope 109:858–861
Aly A, Devitt PG, Watson DI et al (2004) Endoscopic stapling for pharyngeal pouch: does it make the cut? ANZ J Surg 74:116–121
Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877
Carlini M, Dell’Avanzato R, Miercadante E et al (2007) Surgical treatment of a severe, massive, symptomatic Zenker’s diverticulum in a very elderly patient. Chir Italiana 59:397–403
Onwugbufor MT, Obirieze AC, Ortega G et al (2013) Surgical management of esophageal diverticulum: a review of the nationwide inpatient sample database. J Surg Res 184:120–125
Tabola R, Lewandowski A, Cirocchi R et al (2018) Zenker diverticulum: experience in surgical treatment of large diverticula. Medicine (Baltimore) 97:e0557
American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator. (2020) [Cited 12 November 2020]. Available from: http:// https://riskcalculator.facs.org/RiskCalculator/
Liu DS, Cheng C, Islam R et al (2020) Prophylactic negative-pressure dressings reduce wound complications and resource burden after emergency laparotomies. J Surg Res 257:22–31
Howell RJ, Giliberto JP, Harmon J et al (2019) Open versus endoscopic surgery of Zenker’s diverticula: a systematic review and meta-analysis. Dysphagia 34:930–938
Verdonck J, Morton RP (2015) Systematic review on treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol 272:3095–3107
Crawley B, Dehom S, Tamares S et al (2019) Adverse events after rigid and flexible endoscopic repair of Zenker’s diverticula: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 161:388–400
Yuan Y, Zhao YF, Hu Y et al (2013) Surgical treatment of Zenker’s diverticulum. Dig Surg 30:207–218
Chang CW, Burkey BB, Netterville JL et al (2004) Carbon dioxide laser endoscopic diverticulotomy versus open diverticulectomy for Zenker’s diverticulum. Laryngoscope 114:519–527
Acknowledgements
We would like to acknowledge Ms. Tanya Irvine for her assistance in data management.
Author information
Authors and Affiliations
Contributions
All authors contributed to study design, data acquisition, data analysis, data interpretation, writing, and final approval of the manuscript. All authors are accountable for the integrity of this study.
Corresponding author
Ethics declarations
Conflicts of interest
The author declares that they have no conflict of interest.
Ethics approval
This study was approved by the South Adelaide Local Health Network Human Research Ethics Committee.
Informed consent
Informed consent was waived by the Human Research Ethics Committee for this project.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Afzal, M., Liu, D.S., Bright, T. et al. Pharyngeal Pouch Surgery in Octo- and Nonagenarians is Safe and Effective: A Multicentre Comparative Cohort Study. World J Surg 45, 1819–1827 (2021). https://doi.org/10.1007/s00268-021-05999-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-021-05999-4