Advanced age and high American Society of Anesthesiologists’ risk score do not increase perioperative mortality in pancreatic resections: a view from a tertiary care center

Background and Objectives: To evaluate outcomes in elderly patients with high anaesthesiology risk (ASA 4) who underwent pancreatic resection compared to younger patients and elderly patients with lower anaesthesiology risk. Materials and Methods: A consecutive series of 345 patients who underwent pancreatic resection at our tertiary care centre 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 ³75 years (group C). In addition, patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. Prospectively collected data regarding pre-, intra-, post-operative course and follow up of patients belonging to these two subgroups were retrospectively analysed and compared. Results: The group A consisted in 117 (34%) patients, the group B in 128 (37%) patients, and group C in 100 (29%) patients. Group C patients had a significant higher incidence of comorbidities and ASA 4 respect the other two groups (p<0.05). The incidence of the overall post-operative complications was significantly higher in the group C (p<0.01), due to the higher incidence of medical complications. No difference in term of overall surgical complications was reported between the three groups. No difference was documented for post-operative mortality between the three groups. The mean overall survival was significantly lower for group C (p<0.01), but no difference in mortality for cancer was reported between the three groups. Within Group C, the comparison between patients with ASA score 1-3 and ASA 4 showed no significant differences regarding surgical complications (p=0.59), reoperation rate (p=0.45), mortality (p=0.34) and mean overall survival (p=0.53). Conclusion: Although elderly patients presented a higher rate of postoperative complications and a lower mean overall survival, they did not show a higher perioperative mortality. Furthermore, mortality due to cancer in operated patients was not different between the three groups. For these reasons, the advanced age should not be considered a reason to preclude the surgical option to elderly patients with pancreatic cancer . Furthermore, no differences were found in short-term and long-term survival in elderly patients with different operative risk factors (ASA score) , so the higher anesthesiological risk in subjects aged ≥ 75 years should not be considered an absolute contraindication to surgical treatment.