Laparoscopic pancreaticoduodenectomy safe for octogenarians

Laparoscopic pancreaticoduodenectomy (LPD) is a safe procedure in elderly patients with periampullary tumours (PAT) needing surgery, a recent study has found.

The study included 71 octogenarians with PAT, who were divided into two groups: 38 underwent surgery (PD), while the remaining 33 did not (NPD). The PD group was further subdivided into two groups of patients who received either open (OPD; n=19) or laparoscopic (LPD; n=19) surgery.

Kaplan-Meier analysis revealed that overall survival was significantly better in patients who underwent surgery vs those who did not (PD vs NPD: 43.04 vs 11.91 months; p<0.05). Meanwhile, no such difference was reported between the surgery subgroups. Mean survival in the LPD group was 43.00 months, while that in the OPD group was 31.47 months (p=0.816).

Similarly, postoperative complications occurred at comparable rates between the LPD and OPD groups (78.9 percent for both; p>0.999). Biochemical leak, for instance, occurred in only three OPD patients and two LPD patients (p>0.999). Major complications at least grade 3 in severity arose in one OPD patient and two LPD patients (p>0.999).

Moreover, intraoperative blood loss (p=0.102) and length of hospital stay (p=0.885) were likewise comparable between OPD and LPD groups. In contrast, LPD operation time was significantly longer than OPD (338 vs 441 minutes; p<0.0001).

“LPD does not appear to have a clear clinical advantage over OPD; therefore, further research in this area is warranted,” the researchers said.

“To this end, it is thought that in operable octogenarians, laparoscopic and open surgery can be properly adjusted for safe PD procedures according to the condition of the patient, desires of the patient or guardian, and the preference of the surgeon,” they added.