• Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary-Pancreatic-Intestinal of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
LI Jingdong, Email: lijingdong358@126.com
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Objective To investigate perioperative safety of laparoscopic pancreaticoduodenectomy (LPD) in elderly patients (age≥70 years old).Methods The retrospective cohort study was conducted. The clinicopathologic data of the patients underwent LPD and open pancreaticoduodenectomy (OPD) in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2019 were collected. The patients who met the inclusion and exclusion criteria were divided into LPD with aged ≥70 years old group (group A), OPD with aged ≥70 years old group (group B), and LPD with aged <70 years old group (group C). The baseline data, intraoperative situations, and postoperative situations were compared between the group A and group B, and between the group A and group C, respectively.Results ① There were no statistic differences in the age, gender, body mass index, hemoglobin, albumin, and total bilirubin, American Society of Anesthesiologists (ASA) grade, and comorbidity index before operation between the group A and group B (P>0.05); However, there were statistic differences in the hemoglobin, albumin, and total bilirubin, ASA score, and comorbidity index before operation between the group A and group C (P<0.05). ② There were no significant differences in the operation time between the group A and group B (P>0.05), but the intraoperative blood loss of the group A was significantly less than the group B (P<0.05). The operation time, intraoperative blood loss, and conversion rate had no significant differences between the group A and group C (P>0.05). ③There were no significant differences in the pathological pattern, tumor size, R0 resection rate, reoperative rate, and postoperative 90 d mortality between the group A and group B, and between the group A and group C, respectively. For the elderly patients, cases in the ICU, overall complications, specific complications (except for delayed gastric emptying) and complication Clavien-Dindo classification after operation had no significant differences between Group A and group B (P>0.05), but there were more harvesting lymph nodes, lower postoperative pain score, shorter postoperative hospital stay, and less delayed gastric emptying cases in the group A than the group B (P<0.05). For the patients accepted LPD, there were no significant differences in the harvesting lymph nodes, postoperative pain score, postoperative hospital stay, and specific complications (except for pulmonary infection rate) between the group A and the group C (P>0.05), but the postoperative cases in the ICU, pulmonary infection rate, overall complications and the ratio of Clavien-Dindo complication Ⅲ–Ⅳ classification in the group A were significantly higher than the group C (P<0.05),Conclusions Compared with OPD, LPD might have some advantages in blood loss, harvesting lymph nodes, and recovery after surgery, even though perioperative safety of LPD in elderly patients is inferior to younger patients.