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.
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Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 220:530–536
Matsuoka L, Selby R, Genyk Y (2012) The surgical management of pancreatic cancer. Gastroenterol Clin N Am 41:211–221
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
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
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
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
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
Yamada S, Shimada M, Utsunomiya T et al (2012) Surgical results of pancreatoduodenectomy in elderly patients. Surg Today 42:857–862
Adham M, Bredt LC, Robert M et al (2014) Pancreatic resection in elderly patients: should it be denied? Langenbecks Arch Surg 399:449–459
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
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
Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356
Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142
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
WHO (2015) Global health observatory data repository: life expectancy—data by country (CSV). World health statistics 2015. World Health Organization, Geneva
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13
Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198
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
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
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
Braga M, Pecorelli N, Ariotti R et al (2014) Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg 38:2960–2966
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
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
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
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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
- ERAS protocol
- Elderly patient
- Morbidity and mortality