Perioperative outcomes in elderly patients undergoing pancreatoduodenectomy: a propensity-matched analysis.

Background: To investigate perioperative outcomes of pancreatoduodenectomy in elderly patients.

Method: Data for 977 patients who underwent pancreatoduodenectomy from January 2018 to January 2023 were retrospectively analysed. Patients aged 75 years or older (n = 81) were matched with patients younger than 75 years (n = 896) using nearest neighbour propensity scores matching in a 1:1 ratio.

Result: After matching, there were no significant differences in perioperative characteristics between the old group (n = 80) and the young group (n = 80). Regarding perioperative outcomes, we observed a higher incidence of postpancreatectomy haemorrhage (13.8% vs. 3.8%; P = 0.025) and pulmonary infection (26.3% vs. 8.8%; P = 0.004) in the old group. The major morbidity (Clavien-Dindo ≥3), cardiovascular complications and length of stay were higher in the old group before matching, however, no difference was observed between the matched cohorts (P > 0.05). The multivariate analysis revealed ASA score ≥3 (OR = 3.672, 95% CI 1.367-9.863; P = 0.010) and longer operative time (OR = 1.006, 95% CI 1.000-1.011; P = 0.039) were independently identified as risk factors for major morbidity. Moreover, the subgroup analysis demonstrated that laparoscopic surgery significantly mitigated the incidence of major morbidity in elderly patients.

Conclusion: With careful patient selection and perioperative management, elderly patients may achieve comparable short-term outcomes to those of their younger counterparts.