Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 4/2021

01-04-2021 | Scientific Review

Minimally Invasive Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis

Authors: Jisheng Zhu, Guiyan Wang, Peng Du, Jianpeng He, Yong Li

Published in: World Journal of Surgery | Issue 4/2021

Login to get access

Abstract

Background

Minimally invasive pancreaticoduodenectomy (MIPD) for pancreatic head or periampullary lesions is being utilized with increasing frequency. However, few data are available for the elderly. The objective of this study is to assess the safety and feasibility of MIPD in elderly population, by making a comparison with conventional open pancreaticoduodenectomy (OPD) and with non-elderly population.

Methods

We conducted a systematic search to identify all eligible studies in Cochrane Library, Ovid, and PubMed from their inception up to April 2020.

Results

Seven retrospective studies involving 2727 patients were included. Of these, 3 compared MIPD and OPD in elderly patients, 2 compared MIPD in elderly and non-elderly patients, and 2 included both outcomes. Compared to those with OPD, elderly patients who underwent MIPD were associated with less 90-day mortality (OR 0.56, 95% CI 0.32–0.97; P = 0.04) and fewer delayed gastric emptying (OR 0.54, 95% CI 0.33–0.88; P = 0.01). On the other hand, no significant difference was observed in terms of 30-day mortality, major morbidity, postoperative pancreatic fistula (grade B/C), postoperative hemorrhage, reoperation, 30-day readmission, and operative time. For patients who have treated with MIPD, elderly did not reveal worse outcomes than non-elderly.

Conclusion

MIPD is a safe and feasible procedure for select elderly patients if performed by experienced surgeons from high-volume pancreatic surgery centers. However, further randomized studies are required to confirm this.
Literature
1.
United Nations (2019) Department of Economic and Social Affairs, Population Division. World Population Prospects 2019: Ten Key Findings
2.
3.
Ramai D, Ofosu A, Singh J et al (2019) Demographics, tumor characteristics, treatment, and clinical outcomes of patients with ampullary cancer: a surveillance, epidemiology, and end results (SEER) cohort study. Minerva Gastroenterol Dietol 65:85–90PubMed
4.
Carrère N, Mathonnet M, Mirallié É et al (2013) Surgical treatment. Ann Endocrinol 74:191–195CrossRef
5.
Gagner M, Pomp A (1994) Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc 8:408–410CrossRefPubMed
6.
Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784CrossRefPubMed
7.
Palanivelu C, Senthilnathan P, Sabnis SC et al (2017) Randomized clinical trial of laparoscopic versus open pancreatoduodenectomy for periampullary tumours. Br J Surg 104:1443–1450CrossRefPubMed
8.
Poves I, Burdío F, Morató O et al (2018) Comparison of perioperative outcomes between laparoscopic and open approach for pancreatoduodenectomy: the padulap randomized controlled trial. Ann Surg 268:731–739CrossRefPubMed
9.
van Hilst J, de Rooij T, Bosscha K et al (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4:199–207CrossRefPubMed
10.
11.
Peng L, Zhou Z, Cao Z et al (2019) Long-term oncological outcomes in laparoscopic versus open pancreaticoduodenectomy for pancreatic cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 29:759–769CrossRefPubMed
12.
13.
Urbonas K, Gulbinas A, Smailyte G et al (2015) Factors influencing survival after pancreatoduodenectomy for ductal adenocarcinoma depend on patients’ age. Dig Surg 32:60–67CrossRefPubMed
14.
Miyazaki Y, Kokudo T, Amikura K et al (2016) Age does not affect complications and overall survival rate after pancreaticoduodenectomy: Single-center experience and systematic review of literature. Biosci Trends 10:300–306CrossRefPubMed
15.
El Nakeeb A, Atef E, El Hanafy E et al (2016) Outcomes of pancreaticoduodenectomy in elderly patients. Hepatobiliary Pancreat Dis Int 15:419–427CrossRefPubMed
16.
Buchs NC, Addeo P, Bianco FM et al (2010) Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years: a comparative study. World J Surg 34:2109–2114CrossRefPubMed
17.
Tee MC, Croome KP, Shubert CR et al (2015) Laparoscopic pancreatoduodenectomy does not completely mitigate increased perioperative risks in elderly patients. HPB 17:909–918CrossRefPubMedPubMedCentral
18.
Chapman BC, Gajdos C, Hosokawa P et al (2018) Comparison of laparoscopic to open pancreaticoduodenectomy in elderly patients with pancreatic adenocarcinoma. Surg Endosc 32:2239–2248CrossRefPubMed
19.
Meng L, Xia Q, Cai Y et al (2019) Impact of patient age on morbidity and survival following laparoscopic pancreaticoduodenectomy. Surg Laparosc Endosc Percutan Tech 29:378–382CrossRefPubMed
20.
21.
Liang Y, Zhao L, Jiang C et al (2020) Laparoscopic pancreaticoduodenectomy in elderly patients. Surg Endosc 34:2028–2034CrossRefPubMed
22.
Tan Y, Tang T, Zhang Y et al (2020) Laparoscopic vs open pancreaticoduodenectomy a comparative study in elderly people. Updates Surg 72(3):701–707CrossRefPubMed
23.
Moher D, Liberati A, Tetzlaff J et al (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341CrossRefPubMed
24.
Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed
25.
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 161:584–591CrossRefPubMed
26.
Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768CrossRefPubMed
27.
Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed
28.
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed
29.
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed
30.
31.
Delitto D, Luckhurst CM, Black BS et al (2016) Oncologic and perioperative outcomes following selective application of laparoscopic pancreaticoduodenectomy for periampullary malignancies. J Gastrointest Surg 20:1343–1349CrossRefPubMedPubMedCentral
32.
Nussbaum DP, Adam MA, Youngwirth LM et al (2016) Minimally invasive pancreaticoduodenectomy does not improve use or time to initiation of adjuvant chemotherapy for patients with pancreatic adenocarcinoma. Ann Surg Oncol 23:1026–1033CrossRefPubMed
33.
Kantor O, Talamonti MS, Sharpe S et al (2017) Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy. Am J Surg 213:512–515CrossRefPubMed
34.
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 270:1147–1155CrossRefPubMed
35.
Sowmya N, Martin Allison N, Turrentine Florence E et al (2018) Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death. J Surg Res 231:304–308CrossRef
36.
Zureikat AH, Postlewait LM, Liu Y et al (2016) A multi-institutional comparison of perioperative outcomes of robotic and open pancreaticoduodenectomy. Ann Surg 264:640–649CrossRefPubMed
37.
Adam MA, Thomas S, Youngwirth L et al (2017) Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg 152:336–342CrossRefPubMedPubMedCentral
38.
Kutlu OC, Lee JE, Katz MH et al (2018) Open pancreaticoduodenectomy case volume predicts outcome of laparoscopic approach: a population-based analysis. Ann Surg 267:552–560CrossRefPubMed
39.
Qu H, Sun GR, Zhou SQ, He QS (2013) Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis. Eur J Surg Oncol 39:213–223CrossRefPubMed
40.
Dokmak S, Ftériche FS, Aussilhou B et al (2015) Laparoscopic pancreaticoduodenectomy should not be routine for resection of periampullary tumors. J Am Coll Surg 220:831–838CrossRefPubMed
41.
Napoli N, Kauffmann EF, Menonna F et al (2018) Robotic versus open pancreatoduodenectomy: a propensity score-matched analysis based on factors predictive of postoperative pancreatic fistula. Surg Endosc 32:1234–1247CrossRefPubMed
42.
Zhang H, Guo X, Xia J et al (2018) Comparison of totally 3-dimensional laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy. Pancreas 47:592–600CrossRefPubMed
43.
Chen S, Chen JZ, Zhan Q et al (2015) Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc 29:3698–3711CrossRefPubMed
Metadata
Title
Minimally Invasive Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis
Authors
Jisheng Zhu
Guiyan Wang
Peng Du
Jianpeng He
Yong Li
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 4/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05945-w

Other articles of this Issue 4/2021

World Journal of Surgery 4/2021 Go to the issue

Original Scientific Report

Hybrid Surgical Hot Clinic (HSHC): Evaluation of Surgical Hot Clinic Services during COVID-19 Lockdown

Original Scientific Report

Compromised Gut Associated Lymphoid Tissue is a Risk Factor for Postoperative Septic Complications in HIV-Seropositive Trauma Patients

Innovative Surgical Techniques Around the World

The R4U Planes for the Zonal Demarcation for Safe Laparoscopic Cholecystectomy

Reply, Letter to the Editor

Authors’ Reply: 18F-fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism

Invited Commentary

Enhanced Recovery Protocols for Cardiac Surgery: Moving the Saw in the Right Direction

Original Scientific Report

Prognostic Factors in Curative Resected Locoregional Small Intestine Neuroendocrine Neoplasms