八旬老人胰十二指肠切除术后的疗效：系统回顾和荟萃分析

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-12-01 DOI:10.1016/j.hpb.2024.08.007

Joseph Phillipos , Kai-Zheong Lim , Helen Pham , Yazmin Johari , Charles H.C. Pilgrim , Marty Smith

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引用次数: 0

摘要

越来越多的老年患者被诊断出患有胰腺癌，因此越来越需要考虑进行胰腺手术。本研究旨在提供最新的系统综述和荟萃分析，以评估八旬老人胰十二指肠切除术后的疗效。通过检索 Medline、PubMed 和 Cochrane 数据库进行了系统回顾和荟萃分析。纳入的研究比较了接受胰十二指肠切除术的 80 岁以上患者和年轻患者的疗效。共纳入 26 项研究。共纳入 22481 例患者，其中 20134 例（89.6%）年龄小于 80 岁，2347 例（10.4%）为八旬老人。八旬老人的死亡率（OR 2.37（95%CI 1.91-2.94，P<0.00001））、全因发病率（OR 1.60（95%CI 1.30-1.96），P<0.00001）和再次手术率（OR 1.41（95%CI 1.13-1.75），P = 0.002）均较高。八旬老人出现心脏并发症和呼吸系统并发症的风险是正常人的两倍（OR 2.13（95%CI 1.67-2.73），p < 0.00001），（OR 2.38（95%CI 1.72-3.27），p < 0.0001）。在术后胰瘘、胰腺切除术后出血或胃排空延迟方面没有差异。年轻患者更有可能恢复辅助治疗（OR 0.20 (95%CI 0.12-0.34), p < 0.00001）。八旬老人的死亡率和术后并发症较高，接受辅助治疗的可能性也较低。谨慎的术前评估和选择老年患者考虑胰腺手术至关重要。

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Outcomes following pancreaticoduodenectomy for octogenarians: a systematic review and meta-analysis

Background

An increasing number of elderly patients are being diagnosed with pancreatic cancer, with increasing need to consider pancreatic surgery. This study aims to provide an updated systematic review and meta-analysis to evaluate the outcomes following pancreaticoduodenectomy in octogenarians.

Methods

A systematic review and meta-analysis was performed via a search of Medline, PubMed and Cochrane databases. Studies comparing outcomes of patients >80 years to younger patients undergoing PD were included.

Results

26 studies were included. This included 22481 patients, with 20134 (89.6%) aged <80 years old, and 2347 (10.4%) octogenarians. Octogenarians were associated with higher rates of mortality (OR 2.37 (95%CI 1.91-2.94, p < 0.00001)), all-cause morbidity (OR 1.60 (95%CI 1.30-1.96), p<0.00001) and re-operation (OR 1.41 (95%CI 1.13-1.75), p = 0.002). Octogenarians had a two-fold risk of cardiac complications and respiratory complications (OR 2.13 (95%CI 1.67-2.73), p < 0.00001), (OR 2.38 (95%CI 1.72-3.27), p < 0.0001). There was no difference in postoperative pancreatic fistula, post-pancreatectomy hemorrhage or delayed gastric emptying. Younger patients were more likely to return to adjuvant therapy (OR 0.20 (95%CI 0.12-0.34), p < 0.00001).

Conclusions

Octogenerians are associated with higher mortality rate, postoperative complications, and reduced likelihood to undergo adjuvant therapy. Careful preoperative assessment and selection of elderly patients for consideration of pancreatic surgery is essential.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).