Surgical results of pancreatoduodenectomy in elderly patients.
ABSTRACT To assess the safety and feasibility of pancreatoduodenectomy (PD) in elderly patients, we investigated the clinical characteristics of patients aged ≥75 years, who underwent this procedure at our hospital.
Between November 2005 and December 2010, 84 patients underwent PD at Tokushima University Hospital. We analyzed the clinicopathological data and outcomes after PD in patients aged ≥75 years compared with those in patients <75 years.
The preoperative characteristics of the elderly group (n = 28) were similar to those of the younger group (n = 56). The hemoglobin and albumin levels were significantly lower in the elderly patients (P < 0.05), who also had a higher rate of preoperative pulmonary dysfunction (P < 0.05). The operation time and intraoperative blood loss did not differ significantly between the groups, but the incidence of pneumonia was higher in the elderly group (P < 0.05). The overall survival rate did not differ significantly between the groups.
Advanced age alone does not have an adverse effect on surgical outcomes, including postoperative complications and long-term prognosis. Therefore, PD may be justified for selected elderly patients.
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ABSTRACT: To define the clinical characteristics and outcome of preoperative hypoalbuminemia in adult cardiovascular surgery. Inception cohort. Adult cardiovascular intensive care unit (CVICU). Admissions to CVICU between January 1 and December 31, 1993. Preoperative hypoalbuminemia (serum albumin < or = 3.5 g/dL) was classified by the presence of malnutrition cachexia (body mass index of < or = 20 kg/m2), liver insufficiency (serum bilirubin > or = 2.0 mg/dL), history of congestive heart failure, or hypoalbuminemia alone. Demographics, chronic diseases, systemic hemodynamics, and laboratory data were obtained at preoperative and later on admission and during the stay in the CVICU. Postoperative organ dysfunction, nosocomial infections, length of mechanical ventilation, hospitalization and death. A total of 2,743 patients (91%) of 3,025 patients who were admitted to the CVICU were enrolled in the study. Preoperative hypoalbuminemia was found in 325 patients (12%): hypoalbuminemia and cachexia in 21 patients (6%), hypoalbuminemia and liver insufficiency in 26 patients (8%), hypoalbuminemia and history of congestive heart failure in 102 patients (31%), and hypoalbuminemia alone in 176 patients (54%). Clinical features of preoperative hypoalbuminemia were age > or = 75 years, female gender, left ventricular ejection fraction < or = 35%, hematocrit < or = 34%, serum creatinine > or = 1.9 mg/dL, systemic oxygen delivery < or = 350 mL/min.m2, acute stressful conditions (eg, infective endocarditis, acute myocardial infarction, or emergency surgery) and chronic obstructive pulmonary airway disease. Redo operations, combined valve and coronary artery bypass graft, mitral valve replacement, and thoracic aortic surgery were the commonest types of surgery performed in these patients. All types of hypoalbuminemia except for malnutrition cachexia increased the likelihood of postoperative organ dysfunction (cardiac, pulmonary, renal, hepatic, and neurologic), gastrointestinal bleeding, nosocomial infections, length of mechanical ventilation, stay in the CVICU, and hospital death. Cachectic hypoalbuminemia increased the requirement for postoperative parenteral nutrition and prolonged the length of stay in hospital. Preoperative hypoalbuminemia was attributed to malnutrition cachexia, liver insufficiency or congestive heart failure in < 50% of cardiac patients undergoing cardiovascular surgery. All types of hypoalbuminemia except for malnutrition cachexia increased the likelihood of postoperative organ dysfunction, nosocomial infections, prolonged mechanical ventilation, and death. The morbidity and mortality attributed to hypoalbuminemia could be explained by the underlying clinical characteristics rather than malnutrition cachexia in cardiac patients.Journal of Parenteral and Enteral Nutrition 01/1997; 21(2):81-90. · 2.49 Impact Factor
- Annals of Surgery 07/1945; 121(6):847-52. · 6.33 Impact Factor
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ABSTRACT: Postoperative pancreatic fistula (POPF) is still regarded as a major complication. The incidence of POPF varies greatly in different reports, depending on the definition applied at each surgical center. Our aim was to agree upon an objective and internationally accepted definition to allow comparison of different surgical experiences. An international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easy-to-apply definition of POPF, graded primarily on clinical impact. A POPF represents a failure of healing/sealing of a pancreatic-enteric anastomosis or a parenchymal leak not directly related to an anastomosis. An all-inclusive definition is a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity. Three different grades of POPF (grades A, B, C) are defined according to the clinical impact on the patient's hospital course. The present definition and clinical grading of POPF should allow realistic comparisons of surgical experiences in the future when new techniques, new operations, or new pharmacologic agents that may impact surgical treatment of pancreatic disorders are addressed.Surgery 08/2005; 138(1):8-13. · 3.37 Impact Factor