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

Background The decision to submit elderly patients with pancreatic cancer to surgery is still controversial, not so much for the age itself, but rather for the associated comorbidities. The aim of this study is to evaluate the outcome of elderly patients with higher American Society of Anesthesiologists’risk score(ASA 4) underwent pancreatic resection, compared with younger patients and with elderly patient with lower anaesthesiological risk. Methods A consecutive series of 345 patients underwent pancreatic surgery for cancer at our tertiary care centre between 2010 and 2017 was reviewed. We compared three groups based on age:<65 years(A), 65-74 years(B), and 75 years(C). Moreover, group C patients were divided in two subgroups according to ASA score: ASA1-3 (low-medium risk) vs ASA4 (high risk). Prospectively collected data regarding perioperative course and follow up were retrospectively analysed and compared. Results Group A counts 117(34%) patients, group B 128(37%) and group C 100(29%). Group C patients had a significant higher incidence of comorbidities and ASA4 respect the others(p<0.05). The rate of overall postoperative complications were significantly higher in group C(p<0.01), due to the higher incidence of medical complications. Instead, no difference in overall surgical complications was reported. The reoperation rate was higher in group C(12%) vs B(2.3%)(p<0.001) but not vs group A(6%)(p=0.15). No difference was documented for post-operative mortality. 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 ASA1-3 and ASA4 patients showed no significant differences regarding surgical complications, reoperation rate, mortality and mean overall survival. Conclusions Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically. Furthermore, a high anesthesiological risk score (ASA 4) in subjects aged ≥75 years should not be considered an absolute contraindication to pancreatic resection.