Skip to main content
SpringerLink
Log in

Laparoscopic vs. open pancreaticoduodenectomy: a comparative study in elderly people

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

The purpose of the study is to evaluate whether laparoscopic pancreatoduodenectomy (LPD) is safe and feasible for elderly patients. From December 2015 to January 2019, 142 LPD surgeries and 93 OPD surgeries were performed by the same surgeon in the third affiliated hospital of Soochow University. After applying the inclusion and exclusion criteria, we retrospectively collected the date of three defined groups: LPD aged < 70 years (group I, 84 patients), LPD aged ≥ 70 years (group II, 56 patients) and OPD aged ≥ 70 years (group III, 28 patients). Baseline characteristics and short-term surgical outcomes of group I and group II, group II and group III were compared. Totally, 168 patients were included in this study; 100 cases were men; 68 cases were women; mean age was 67.9 ± 9.5 years. LPD does not perform as well in elderly as it does in non-elderly patients in terms of intraoperative blood loss (300.0 (200.0–500.0) ml vs. 200.0 (100.0–300.0) ml, p = 0.003), proportion of intraoperative transfusion (17.9% vs. 6.0%, p = 0.026) and time to oral intake (5.0 (4.0–7.0) day vs. 5.0 (3.0–6.0) day, p = 0.036). Operative time, conversion rate, postoperative stay, and proportion of reoperation, Clavien–Dindo classification, 30-day readmission and 90-day mortality were similar in two groups. In elderly patients, when compared with OPD, LPD had the advantage of shorter time to start oral intake (5.0 (4.0–7.0) day vs. 7.0 (5.0–11.3) day, p = 0.005) but the disadvantage of longer operative time (380.0 (306.3–447.5) min vs. 292.5 (255.0–342.5) min, p < 0.001) and higher hospitalization cost (12447.3 (10,189.7–15,340.0) euros vs. 7251.9 (8994.0–11,717.4) euros, p < 0.001). There was no difference between the two groups in terms of postoperative stay, and proportion of reoperation, Clavien–Dindo classification, 30-day readmission and 90-day mortality. LPD is safe and feasible for elderly people, but we need to consider its high cost and long operative time over OPD.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. He X, Song M, Qu J et al (2019) Basic and translational aging research in China: present and future. Protein Cell 10(7):476–484

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sukharamwala P, Thoens J, Szuchmacher M et al (2012) Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB 14(10):649–657

    Article  PubMed  Google Scholar 

  3. Yuan F, Essaji Y, Belley-Cote EP et al (2018) Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. A retrospective cohort study. Int J Surg 60:204–209

    Article  PubMed  Google Scholar 

  4. Chen YT, Ma FH, Wang CF et al (2018) Elderly patients had more severe postoperative complications after pancreatic resection: a retrospective analysis of 727 patients. World J Gastroenterol 24(7):844–851

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chen K, Liu XL, Pan Y et al (2018) Expanding laparoscopic pancreaticoduodenectomy to pancreatic-head and periampullary malignancy: major findings based on systematic review and meta-analysis. BMC Gastroenterol 18(1):102

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhou J, Xin C, Xia T et al (2017) Laparoscopic pancreaticoduodenectomy in A-92-older Chinese patient for cancer of head of the pancreas: a case report. Medicine 96(3):e5962

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161(3):584–591

    Article  PubMed  Google Scholar 

  8. Lu L, Zhang X, Tang G et al (2018) Pancreaticoduodenectomy is justified in a subset of elderly patients with pancreatic ductal adenocarcinoma: a population-based retrospective cohort study of 4,283 patients. Int J Surg 53:262–268

    Article  PubMed  Google Scholar 

  9. Shamali A, De’Ath HD, Jaber B et al (2017) Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy. Int J Surg 45:138–143

    Article  PubMed  Google Scholar 

  10. Ito Y, Kenmochi T, Irino T et al (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102

    Article  PubMed  PubMed Central  Google Scholar 

  11. Croome KP, Farnell MB, Que FG et al (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260(4):633–638 (discussion 638-640)

    Article  PubMed  Google Scholar 

  12. de Rooij T, Lu MZ, Steen MW et al (2016) Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 264(2):257–267

    Article  PubMed  Google Scholar 

  13. Palanivelu C, Senthilnathan P, Sabnis SC et al (2017) Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg 104(11):1443–1450

    Article  CAS  PubMed  Google Scholar 

  14. Mesleh MG, Stauffer JA, Bowers SP et al (2013) Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison. Surg Endosc 27(12):4518–4523

    Article  PubMed  Google Scholar 

  15. Gerber MH, Delitto D, Crippen CJ et al (2017) Analysis of the cost effectiveness of laparoscopic pancreatoduodenectomy. J Gastrointest Surg 21(9):1404–1410

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tan CL, Zhang H, Peng B et al (2015) Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy. World J Gastroenterol 21(17):5311–5319

    Article  PubMed  PubMed Central  Google Scholar 

  17. Poves I, Burdio F, Morato O et al (2018) Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the PADULAP randomized controlled trial. Ann Surg 268(5):731–739

    Article  PubMed  Google Scholar 

  18. Torphy RJ, Friedman C, Halpern A et al (2019) Comparing short-term and oncologic outcomes of minimally invasive versus open pancreaticoduodenectomy across low and high volume centers. Ann Surg 270(6):1147–1155

    Article  PubMed  Google Scholar 

  19. Liang Y, Zhao L, Jiang C et al (2019) Laparoscopic pancreaticoduodenectomy in elderly patients. Surg Endosc. https://doi.org/10.1007/s00464-019-06982-w

    Article  PubMed  Google Scholar 

  20. Lee CS, Kim EY, You YK et al (2018) Perioperative outcomes of laparoscopic pancreaticoduodenectomy for benign and borderline malignant periampullary disease compared to open pancreaticoduodenectomy. Langenbecks Arch Surg

  21. Tee MC, Croome KP, Shubert CR et al (2015) Laparoscopic pancreatoduodenectomy does not completely mitigate increased perioperative risks in elderly patients. HPB 17(10):909–918

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chapman BC, Gajdos C, Hosokawa P et al (2018) Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc 32(5):2239–2248

    Article  PubMed  Google Scholar 

  23. Adam MA, Thomas S, Youngwirth L et al (2017) Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg 152(4):336–342

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kutlu OC, Lee JE, Katz MH et al (2018) Open pancreaticoduodenectomy case volume predicts outcome of laparoscopic approach: a population-based analysis. Ann Surg 267(3):552–560

    Article  PubMed  Google Scholar 

  25. Evered L, Silbert B, Knopman DS et al (2018) Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Br J Anaesth 121(5):1005–1012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Witlox J, Eurelings LS, de Jonghe JF et al (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304(4):443–451

    Article  CAS  PubMed  Google Scholar 

  27. Steinmetz J, Christensen KB, Lund T et al (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110(3):548–555

    Article  PubMed  Google Scholar 

  28. Hirpara DH, Azin A, Mulcahy V et al (2019) The impact of surgical modality on self-reported body image, quality of life and survivorship after anterior resection for colorectal cancer—a mixed methods study. Can J Surg 62(4):235–242

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gong GL, Liu B, Wu JX et al (2018) Postoperative cognitive dysfunction induced by different surgical methods and its risk factors. Am Surg 84(9):1531–1537

    PubMed  Google Scholar 

  30. Shin YH, Kim DK, Jeong HJ (2015) Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches. Korean J Anesthesiol 68(4):379–385

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Tan CB, Ng J, Jeganathan R et al (2015) Cognitive changes after surgery in the elderly: does minimally invasive surgery influence the incidence of postoperative cognitive changes compared to open colon surgery? Dement Geriatr Cogn Disord 39(3–4):125–131

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China

    Yuwei Tan, Tianyu Tang, Yue Zhang, Guangchen Zu, Yong An, Weibo Chen, Di Wu, Donglin Sun & Xuemin Chen

Authors
  1. Yuwei Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tianyu Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yue Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guangchen Zu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong An
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weibo Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Di Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Donglin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xuemin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xuemin Chen.

Ethics declarations

Conflict of interest

This manuscript has not been published nor submitted for publication elsewhere. All authors have contributed significantly, and agree with the content of the manuscript. The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Ethical approval

This study has been approved by the Institutional Review Board of Changzhou First People’s Hospital ethics committee, and has been performed according to the ethical standards laid down in the 1964 Declaration of Helsinki.

Research involving human participants and/or animals

The study has been performed in accordance with the ethical standard of the instituional and/or national research committe, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, Y., Tang, T., Zhang, Y. et al. Laparoscopic vs. open pancreaticoduodenectomy: a comparative study in elderly people. Updates Surg 72, 701–707 (2020). https://doi.org/10.1007/s13304-020-00737-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00737-2

Keywords

Search

Navigation