Hongwei Huang, Feng Xia, Tianyin Shao, Baiyong Shen, Xinmin Yin, Xiaoqing Jiang, Deyu Li, Jing Li, Sen Qiao, Songqing He, Heshui Wu, Jiayun Ge, Zhenyu Yin, Guanyu Wang, Haoliang Zhao, Hengquan Ran, Jun Zheng, Guangjun Shi, Jiangtao Yu, Jingfeng Liu, Xiaofeng Liao, Bin Jiang, Weidong Jin, Zhiwei Zhang, Qi Cheng, Xiaoping Chen
The impact of advanced age on pancreaticoduodenectomy (PD) remains controversial, partly due to inconsistent definitions of "elderly". To determine the optimal age cut-off for risk stratification and evaluate the safety of different surgical approaches and anastomotic techniques in elderly patients, this study retrospectively analyzed clinical data of 7,028 patients who underwent PD between 2014 and 2019 at 21 centers. Logistic regression analysis demonstrated that advancing age was significantly associated with increased risks of clinically relevant postoperative pancreatic fistula (CR-POPF), bile leakage, pulmonary infection, intra-abdominal infection, and mortality. The optimal age cut-off for predicting CR-POPF was determined as 65 years using receiver operating characteristic curve analysis and the Youden index. Patients were stratified into younger and elderly groups based on this threshold. Both before and after propensity score matching, the elderly group continued to demonstrate significantly higher rates of CR-POPF (before matching: 9.02% vs. 6.33%, P<0.001; after matching: 9.02% vs. 6.67%, P=0.001), intra-abdominal infection, and mortality (before matching: 1.54% vs. 0.91%, P<0.001; after matching: 1.56% vs. 0.92%, P=0.034). Multivariate analysis identified age >65 years, soft pancreatic texture, and anastomotic technique as independent risk factors for CR-POPF. In elderly patients, minimally invasive PD showed comparable CR-POPF rates to open PD (9.39% vs. 9.12%, P=0.976). Furthermore, Chen's U-suture technique achieved a significantly lower CR-POPF rate in elderly patients compared with both invagination and duct-to-mucosa anastomosis (5.74% vs. 9.61% vs. 9.64%, P=0.045). In conclusion, patients aged >65 years carry increased risks of postoperative complications and mortality following PD. Minimally invasive PD appears equally safe in elderly patients, while Chen's U-suture technique represents the preferred reconstruction method with reduced pancreatic fistula risk.