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Pancreatic resections in elderly patients with high American Society of Anesthesiologists’ risk score: a view from a tertiary care center

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Abstract

Background

More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases.

Aim

To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk.

Methods

A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65–74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1–3 versus ASA 4, and compared.

Results

Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1–3 and ASA 4 patients.

Conclusions

Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.

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Acknowledgements

The authors thank Sabrina L. Maurer, PharmD, CMPP for providing language editing. The authors thank Tizzi, Rotary and Arpa Foundations, and Orvietani’s Family for their support.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. General Surgery Unit, Department of Surgery, Translational Research and New Technologies in Medicine, University of Pisa, Via Paradisa 2, Pisa, 56125, Italy

    Gregorio Di Franco, Matteo Palmeri, Simone Guadagni, Niccolò Furbetta, Desirée Gianardi, Jessica Bronzoni, Alessandro Palma, Matteo Bianchini, Serena Musetti, Giovanni Caprili, Giulio Di Candio & Luca Morelli

  2. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy

    Franco Mosca & Luca Morelli

  3. Institute of Clinical Physiology, National Council of Research, Pisa, Italy

    Luca Bastiani

  4. Division of Transplant Anesthesia and Critical Care, University of Pisa, Pisa, Italy

    Giandomenico Biancofiore

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  1. Gregorio Di Franco
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Contributions

Study conception and design: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. GD, Dr. BJ, Dr. PA, Dr. BM, Dr. MS, Dr. BL, Dr. CG, Prof. BG, Prof. MF, Prof. DCG, Prof. ML; acquisition of data: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. GD, Dr. BJ, Dr. PA, Dr. BM, Dr. MS, Dr. BL, Dr. CG; analysis and interpretation of data: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. BL, Prof. BG, Prof. MF, Prof. DCG, Prof. ML; drafting of manuscript: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. GD, Dr. BJ, Dr. PA, Dr. BM, Dr. MS, Dr. BL, Dr. CG; critical revision of manuscript: Prof. BG, Prof. MF, Prof. DCG, Prof. ML; final approval of the version to be published: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. GD, Dr. BJ, Dr. PA, Dr. BM, Dr. MS, Dr. BL, Dr. CG, Prof. BG, Prof. MF, Prof. DCG, Prof. ML; agreement for all aspects of the work: Dr. DFG, Dr. PM, Dr. GS, Dr. FN, Dr. GD, Dr. BJ, Dr. PA, Dr. BM, Dr. MS, Dr. BL, Dr. CG, Prof. BG, Prof. MF, Prof. DCG, Prof. ML.

Corresponding author

Correspondence to Luca Morelli.

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Di Franco, G., Palmeri, M., Guadagni, S. et al. Pancreatic resections in elderly patients with high American Society of Anesthesiologists’ risk score: a view from a tertiary care center. Aging Clin Exp Res 32, 935–950 (2020). https://doi.org/10.1007/s40520-019-01276-6

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