Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Wang, Qiang; Chen, Chengxin; Li, Haiyang

doi:10.3389/fsurg.2022.807940

Cited by 4 publications

(12 citation statements)

References 34 publications

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“…The most important finding of our study was the significant lower relative risk for 90-day mortality rate in elderly patients that benefited from laparoscopic approach compared to classical surgery (RR = 0.56; 95%CI: 0.32-0.96; p = 0.037). Our results are different from those reported in all aged categories [17] and in the meta-analyses conducted by Wang et al [40] and by Zhang et al [41] focusing on elderly patients, that report similar odds ratio for 90-day mortality rate between OPD and LPD. These differences might be partially explained by different measurement tools and included studies.…”

Section: Discussioncontrasting

confidence: 99%

“…The potential inter-study heterogeneity of our analysis for 90-day mortality was 0%, similar to that reported by Wang et al [40] at 1%; however, Zhang et al [41] reported higher heterogeneity among included studies, which was at 42%. The meta-analysis conducted by Wang et al [40] included one small size study with octogenarians [43], without any death recorded.…”

Section: Discussionsupporting

confidence: 85%

“…In our meta-analysis, even the mortality rate at 90 days postoperatively was higher in elderly patients receiving LPD, the difference was not statistically significant (RR = 2.3; 95%CI: 0.49-10.78; p = 0.29, I 2 = 0%) compared with non-elderly LPD; similar results were observed in the meta-analysis conducted by Wang et al [40]. However, in the meta-analysis conducted by Zhang et al [41] the 90-day mortality rate was statistically significant different, but the heterogeneity of the included studies was higher (RR = 2.29; 95%CI: 1.14-4.6, p = 0.02, I 2 = 0%).…”

Section: Discussionsupporting

confidence: 84%

“…These differences might be partially explained by different measurement tools and included studies. Our study and the meta-analysis performed by Zhang et al [41] reported the risk ratio; the meta-analysis conducted by Wang et al [40] reported the odds ratio. The potential inter-study heterogeneity of our analysis for 90-day mortality was 0%, similar to that reported by Wang et al [40] at 1%; however, Zhang et al [41] reported higher heterogeneity among included studies, which was at 42%.…”

Section: Discussionmentioning

confidence: 53%

“…In this study, we identified and analyzed in a systematic manner data regarding the outcomes of LPD in elderly patients to offer clinicians and surgeons evidence for daily practice. The meta-analyses of previous relevant studies on this topic were recently addressed in two meta-analyses [40,41]. A comprehensive recent meta-analysis summarizing 34 studies involving 46,729 patients compared the outcomes of LPD vs. OPD and provided a subgroup analysis on elderly patients (≥70 years) [42].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Bartoș

Mărgărit

Bocse

et al. 2022

Life

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Background and Aims: Recent single-center retrospective studies have focused on laparoscopic pancreatoduodenectomy (LPD) in elderly patients, and compared the outcomes between the laparoscopic and open approaches. Our study aimed to determine the outcomes of LPD in the elderly patients, by performing a systematic review and a meta-analysis of relevant studies. Methods: A comprehensive literature review was conducted utilizing the Embase, Medline, PubMed, Scopus and Cochrane databases to identify all studies that compared laparoscopic vs. open approach for pancreatoduodenectomy (PD). Results: Five retrospective studies were included in the final analysis. Overall, 90-day mortality rates were significantly decreased after LPD in elderly patients compared with open approaches (RR = 0.56; 95%CI: 0.32–0.96; p = 0.037, I2 = 0%). The laparoscopic approach had similar mortality rate at 30-day, readmission rate in hospital, Clavien–Dindo complications, pancreatic fistula grade B/C, complete resection rate, reoperation for complications and blood loss as the open approach. Additionally, comparing with younger patients (<70 years old), no significant differences were seen in elderly cohort patients regarding mortality rate at 90 days, readmission rate to hospital, and complication rate. Conclusions: Based on our meta-analysis, we identify that LPD in elderly is a safe procedure, with significantly lower 90-day mortality rates when compared with the open approach. Our results should be considered with caution, considering the retrospective analyses of the included studies; larger prospective studies are required.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Bartoș

Mărgărit

Bocse

et al. 2022

Life

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Pancreaticoduodenectomy in patients < 75 years versus ≥ 75 years old: a comparative study

Ergenç,

Uprak,

Özocak

et al. 2024

Aging Clin Exp Res

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Objective This study aimed to compare the postoperative outcomes of < 75-year-old patients and ≥ 75-year-old patients who underwent pancreaticoduodenectomy (PD) for pancreatic head and periampullary region tumors. Methods Patients who underwent PD in our hospital between February 2019 and December 2023 were evaluated. Demographics, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores, American Society of Anesthesiologists (ASA) scores, comorbidities, hospital stays, complications, and clinicopathological features were analyzed. Patients were divided into < 75 years (Group A) and ≥ 75 years (Group B) groups and compared. Results The median age of the entire cohort (n = 155) was 66 years (IQR = 16). There was a significant difference between Group A (n = 128) and Group B (n = 27) regarding the ECOG-PS and ASA scores. There was no significant difference between the groups regarding postoperative complications. The 30-day mortality rate was greater in Group B (p = 0.017). Group B had a cumulative median survival of 10 months, whereas Group A had a median survival of 28 months, with a statistically significant difference (p < 0.001). When age groups were stratified according to ECOG-PS, for ECOG-PS 2–3 Group A, survival was 15 months; for ECOG-PS 2–3 Group B, survival was eight months, and the difference was not statistically significant (p = 0.628). Conclusions With the increasing aging population, patient selection for PD should not be based solely on age. This study demonstrated that PD is safe for patients older than 75 years. In older patients, performance status and the optimization of comorbidities should be considered when deciding on a candidate’s suitability for surgery.

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Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study

Peng

Liu

et al. 2023

International Journal of Surgery

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Background: Textbook outcome (TO) is a composite outcome measure for surgical quality assessment. The aim of this study was to assess TO following laparoscopic pancreaticoduodenectomy (LPD), identify factors independently associated with achieving TO, and analyze hospital variations regarding the TO after case-mix adjustment. Methods: This multicenter cohort study retrospectively analyzed 1029 consecutive patients undergoing LPD at 16 high-volume pancreatic centers in China from January 2010 to August 2016. The percentage of patients achieving TO was calculated. Preoperative and intraoperative variables were compared between the TO and non-TO groups. Multivariate logistic regression was performed to identify factors independently associated with achieving TO. Hospital variations regarding the TO were analyzed by the observed/expected TO ratio after case-mix adjustment. Differences in expected TO rates between different types of hospitals were analyzed using the one-way analysis of variance test. Results: TO was achieved in 68.9% (n=709) of 1029 patients undergoing LPD, ranging from 46.4 to 85.0% between different hospitals. Dilated pancreatic duct (>3 mm) was associated with the increased probability of achieving TO [odds ratio (OR): 1.564; P=0.001], whereas advanced age (≥75 years) and concomitant cardiovascular disease were associated with a lower likelihood of achieving TO (OR: 0.545; P=0.037 and OR: 0.614; P=0.006, respectively). The observed/expected TO ratio varied from 0.62 to 1.22 after case-mix adjustment between different hospitals, but no significant hospital variations were observed. Hospital volume, the surgeon’s experience with open pancreaticoduodenectomy and minimally invasive surgery, and surpassing the LPD learning curve were significantly correlated with expected TO rates. Conclusion: TO was achieved by less than 70% of patients following LPD. Dilated pancreatic ducts, advanced age, and concomitant cardiovascular disease were independently associated with achieving TO. No significant hospital variations were observed after case-mix adjustment.

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Laparoscopic Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Cited by 4 publications

References 34 publications

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Laparoscopic Pancreatoduodenectomy in Elderly Patients: A Systematic Review and Meta-Analysis

Pancreaticoduodenectomy in patients < 75 years versus ≥ 75 years old: a comparative study

Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study

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