Meta-Analysis:
Pancreatoduodenectomy for pancreatic head tumors in the elderly–systematic review and metaanalysis
Michał Pędziwiatr1,2,*, Piotr Małczak1,2,*, Magdalena Mizera1, Jan Witowski1, Grzegorz Torbicz1, Piotr Major1,2, Magdalena Pisarska1,2, Michał Wysocki1,2, Miłosz Jankowski3, Mateusz Rubinkiewicz1, Anna Lasek1, Jan Kulawik1 and Andrzej Budzyński1,2
12nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
2Center for Research, Training and Innovation in Surgery, CERTAIN Surgery, Krakow, Poland
3Department of Anesthesiology and Intensive Care, The University Hospital in Kraków, Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
*These authors contributed equally to this work
Correspondence to:
Michał Pędziwiatr, email: [email protected]
Keywords: pancreatic resection; elderly; octogenarians; meta-analysis; whipple
Received: September 07, 2017 Accepted: March 15, 2018 Published:
ABSTRACT
Objective: This meta-analysis aims to assess the safety of pancreatoduodenectomy in elderly population, primarily focusing on morbidity and mortality.
Summary Background Data: The age at which patients are undergoing pancreatoduodenectomy is increasing worldwide. The data on the outcome of this surgical procedure in the elderly is constantly expanding.
Methods: We searched the Medline, Embase and Cochrane databases to identify eligible studies. The most recent search was performed on 10th April 2017. Inclusion criteria were: (1) comparison of the characteristics and perioperative outcomes of older patients versus younger patients undergoing pancreatoduodenectomy; (2) objective evaluation of mortality or overall morbidity; and (3), publication in English. Exclusion criteria were: (1) a lack of comparative data; (2) a lack of primary outcomes or insufficient data to analyze; (3) a focus on procedures other than pancreatoduodenectomy; or (4), the impossibility of extraction of data specifically concerning pancreatoduodenectomy. Primary outcomes were overall morbidity and mortality. Secondary outcomes analyzed postoperative complications, R0 rate and length of hospital stay.
Results: 45 eligible studies were chosen, with a combined total of 21,295 patients. Older patients compared to younger patients had a higher risk of death (2.26% vs. 4.54%; RR: 2.23; 95% CI 1.74–2.87) and a higher complication rate (47.23% vs. 39.35%; RR: 1.17; 95% CI 1.12–1.24). There were no differences in pancreatic fistula occurrence (p = 0.27), bile leakage (p = 0.81), postoperative hemorrhage (p = 0.08), or R0 rate (p = 0.92).
Conclusions: Our review confirms, that in the case of pancreatoduodenectomy, advanced age is a risk factor for increased non-surgical morbidity and, by extension, higher mortality.