In this multicentre study, only post-operative complications were associated with DGE. Neither pylorus preservation nor route of enteric reconstruction (antecolic versus retrocolic) was associated with delayed gastric emptying.

Current liver allocation policy in the United States grants liver transplant candidates with stage T2 hepatocellular carcinoma (HCC) a priority Model for End-Stage Liver Disease (MELD) score of 22, regardless of age. Because advanced age may portend an increase in all-cause mortality after transplantation for any diagnosis, the aim of this study was to examine overall posttransplant survival in elderly patients with HCC versus younger cohorts. Based on Organ Procurement and Transplantation Network data, Kaplan-Meier 5-year survival rates were compared. Recipients undergoing primary liver transplantation were stratified into cohorts based on age (<70 or 70 years) and the receipt of MELD exception points for HCC. Log-rank and Wilcoxon tests were used for statistical comparisons. In 2009, 143 transplants were performed for patients who were 70 years old or older. Forty-two percent of these patients received a MELD exception for HCC. Regardless of the diagnosis, the overall survival rate was significantly attenuated for the septuagenarians versus the younger cohort. After 5 years of follow-up, this disparity exceeded 10% to 15% depending on the populations being compared. The 1-, 2-, 3-, 4-, and 5-year actuarial survival rates were 88.4%, 83.2%, 79.6%, 76.1%, and 72.7%, respectively, for the patients who were younger than 70 years and 81.1%, 73.8%, 67.1%, 61.9%, and 55.2%, respectively, for the patients who were 70 years old or older. Five-year survival was negatively affected for patients with HCC who were younger than 70 years; this disparity was not observed for patients with HCC who were 70 years old or older. In conclusion, although patients who are 70 years old or older compose a small fraction of transplant recipients in the United States, patients in this group undergoing transplantation for HCC form an even smaller subset. Overall, transplantation in this age group yields outcomes inferior to those for younger cohorts. However, unlike patients who are less than 70 years old and receive MELD exception points, overall liver transplant survival is not affected by HCC at an advanced age.

STRUCTURED ABSTRACT OBJECTIVE AND SUMMARY BACKGROUND DATA For pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers. METHODS We identified 2,694 patients who underwent pancreatic resection from the ACS-NSQIP Pancreatectomy Demonstration Project at 37 high volume centers. Overall morbidity and in-hospital mortality were determined in patients <80 (N=2,496) and ≥80 (N=198) years old. Failure to rescue was the number of deaths in patients with complications divided by the total number of patients with postoperative complications. RESULTS No significant differences were observed between patients <80 and ≥80 in the rates of overall complications (41.4% vs. 39.4%, p=0.58). In-hospital mortality increased in patients ≥80 compared to patients <80 (3.0% vs. 1.1%, p=0.02). Failure to rescue rates were higher in patients ≥80 (7.7% vs. 2.7%, p=0.01). Across 37 high volume centers, unadjusted complication rates ranged from 25.0%–72.2% and failure to rescue rates ranged from 0.0%–25.0%. Among patients with postoperative complications, comorbidities associated with failure to rescue were ascites, COPD, and diabetes. Complications associated with failure to rescue included acute renal failure, septic shock, and postoperative pulmonary complications. CONCLUSION In experienced hands, the rates of complications after pancreatectomy in patients ≥80 compared to patients <80 were similar. However, when complications occurred, older patients were more likely to die. Interventions to identify and aggressively treat complications are necessary to decrease mortality in vulnerable older patients.