Impact of Enhanced Recovery after Surgery protocol on immediate surgical outcome in elderly patients undergoing pancreaticoduodenectomy

Abstract

The numbers of patients undergoing pancreaticoduodenectomy are increasing and considerable percentage is elderly patients. Pancreaticoduodenectomy is a major and complicated surgery. The morbidity and mortality following pancreaticoduodenectomy have significantly reduced in recent times; it still remains unclear in elderly patients. Applications of Enhanced Recovery after Surgery protocol have contributed for this better outcome. In this retrospective study, patients who underwent pancreaticoduodenectomy with Enhanced Recovery after Surgery protocol were included and divided into two groups (< 60 years vs ≥ 60 years). The “elderly patients” (≥ 60 years) were defined based on the WHO definition for Indian subcontinent. Outcomes were analyzed in terms of postoperative morbidity, mortality and length of hospital stay. Total 103 patients underwent pancreaticoduodenectomy during the study period (January 2012–December 2017). The mean age was 56.6 ± 10.32 years. Fifty-six (54.37%) patients were aged < 60 years (young group) and 47 (45.63%) patients were aged ≥ 60 years (elderly group). There was no difference between the groups in terms of age, gender, co-morbidity, preoperative drainage and diagnosis. There was no significant difference in the morbidity and mortality (p > 0.05). Delayed gastric emptying was the most common complication which was 25.24% (21% vs 23.41%). Pancreatic fistula rate was 13.59% (8.9% vs 12.76%) and hemorrhage was 4.85% (5.4% vs 4.3%). Mortality was 4.85%. Postoperative hospital stay was comparable (14.7 days vs 15.3 days) (p = 0.164). Pancreaticoduodenectomy is a safe surgical procedure in elderly patients in comparison to young patients. Application of Enhanced Recovery after Surgery protocol can improve the outcome further.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 220:530–536

    Article  Google Scholar 

  2. 2.

    Matsuoka L, Selby R, Genyk Y (2012) The surgical management of pancreatic cancer. Gastroenterol Clin N Am 41:211–221

    Article  Google Scholar 

  3. 3.

    Gooiker GA, Lemmens VE, Besselink MG et al (2014) Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg 101:1000–1005

    CAS  Article  Google Scholar 

  4. 4.

    Riall TS, Cameron JL, Lillemoe KD et al (2006) Resected periampullary adenocarcinoma: 5-year survivors and their 6-to 10-year follow-up. Surgery 140:764–772

    Article  Google Scholar 

  5. 5.

    Hodul P, Tansey J, Golts E, Oh D, Pickleman J, Aranha GV (2001) Age is not a contraindication to pancreaticoduodenectomy. Am Surg 67:270–275

    CAS  PubMed  Google Scholar 

  6. 6.

    Riall TS, Reddy DM, Nealon WH, Goodwin JS (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248:459–467

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Usuba T, Takeda Y, Murakami K, Tanaka Y, Hanyu N (2014) Clinical outcomes after pancreaticoduodenectomy in elderly patients at middle-volume center. Hepatogastroenterology 61:1762–1766

    PubMed  Google Scholar 

  8. 8.

    Yamada S, Shimada M, Utsunomiya T et al (2012) Surgical results of pancreatoduodenectomy in elderly patients. Surg Today 42:857–862

    Article  Google Scholar 

  9. 9.

    Adham M, Bredt LC, Robert M et al (2014) Pancreatic resection in elderly patients: should it be denied? Langenbecks Arch Surg 399:449–459

    CAS  Article  Google Scholar 

  10. 10.

    Lahat G, Sever R, Lubezky N et al (2011) Pancreatic cancer: surgery is a feasible therapeutic option for elderly patients. World J Surg Oncol 9:10–14

    Article  Google Scholar 

  11. 11.

    Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10:813–822

    Article  Google Scholar 

  12. 12.

    Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356

    Article  Google Scholar 

  13. 13.

    Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142

    Article  Google Scholar 

  14. 14.

    Ouaissi M, Sielezneff I, Pirro N et al (2008) Pancreatic cancer and pancreaticoduodenectomy in elderly patient: morbidity and mortality are increased. Is it the real life? Hepatogastroenterology 55:2242–2246

    PubMed  Google Scholar 

  15. 15.

    WHO (2015) Global health observatory data repository: life expectancy—data by country (CSV). World health statistics 2015. World Health Organization, Geneva

    Google Scholar 

  16. 16.

    Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  Google Scholar 

  17. 17.

    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198

    Article  Google Scholar 

  18. 18.

    Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:172–188

    CAS  Article  Google Scholar 

  19. 19.

    Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577

    Article  Google Scholar 

  20. 20.

    Lassen K, Coolsen MM, Slim K et al (2013) Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg 37:240–258

    Article  Google Scholar 

  21. 21.

    Braga M, Pecorelli N, Ariotti R et al (2014) Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg 38:2960–2966

    Article  Google Scholar 

  22. 22.

    Coolsen MM, Van Dam RM, Chigharoe A, Olde Damink SW, Dejong CH (2014) Improving outcome after pancreaticoduodenectomy: experiences with implementing an enhanced recovery after surgery (ERAS) program. Dig Surg 31:177–184

    Article  Google Scholar 

  23. 23.

    Nikfarjam M, Weinberg L, Low N et al (2013) A fast track recovery program significantly reduces hospital length of stay following uncomplicated pancreaticoduodenectomy. JOP 14:63–70

    PubMed  Google Scholar 

  24. 24.

    Abu Hilal M, Di Fabio F, Badran A et al (2013) Implementation of enhanced recovery programme after pancreatoduodenectomy: a single-centre UK pilot study. Pancreatology 13:58–62

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Lileswar Kaman.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the study patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kaman, L., Chakarbathi, K., Gupta, A. et al. Impact of Enhanced Recovery after Surgery protocol on immediate surgical outcome in elderly patients undergoing pancreaticoduodenectomy. Updates Surg 71, 653–657 (2019). https://doi.org/10.1007/s13304-019-00625-4

Download citation

Keywords

  • ERAS protocol
  • Elderly patient
  • Pancreaticoduodenectomy
  • Morbidity and mortality