The Effect of Age on Pancreaticoduodenectomy; Comorbidities, Short-term Outcomes, and Survival

Objective: To evaluate the complications, mortality, and survival rates of patients aged >70 years undergoing pancreaticoduodenectomy, and to determine associated risk factors. Study Design: Descriptive study. Place and Duration of the Study: General Surgery Clinic of Eskisehir Osmangazi University Medical Faculty Hospital, Eskisehir, Turkiye, from January 2014 to September 2020. Methodology: A retrospective scrutiny of 94 patients who had undergone pancreaticodueodenectomy, was carried out. The patients were separated into two age groups of younger and older than 70 years, and were compared in respect of clinicopathological characteristics, comorbidities, perioperative characteristics, and complications. Independent risk factors for the endpoints of perioperative mortality and survival were investigated. Results: No significant difference was determined between the groups in respect of biochemical values, and perioperative and histochemical characteristics. Comorbidities were present at a higher rate in the older patients (77.8% vs. 38.8%, p<0.001). The postoperative complication rates were similar (33.3% vs. 32.7%, p=0.944). Perioperative mortality (first 30 days) was determined at a significantly higher rate in the older age group (20.0% vs. 4.1%, p=0.016). The age of patients >70 years increased the risk of mortality 4.851 -fold but was not an independent predictive factor (p=0.086). The groups were similar in respect of disease -free survival (DFS) and overall survival (OS, Log -rank p=0.780, p=0.386). Age [Hazard Ratio (HR): 1.029, p=0.048] and pancreas adenocarcinoma (HR: 1.846, p=0.028) were determined to be independent prognostic factors for DFS, and pancreas adenocarcinoma (HR 1.940, p=0.023) for OS. Conclusion: Older age was not seen to change survival in patients undergoing pancreaticoduodenectomy, but mortality within the first 30 days was affected. Age is not accepted as an absolute contraindication. It is recommended that pancreaticoduodenectomy is performed on patients aged >70 years with careful patient selection, prudent preoperative preparation, a meticulous surgical technique, and close multidisciplinary postoperative support.