Pancreatic stump closure after pancreatoduodenectomy in elderly patients. A retrospective clinical study

Background Pancreatic fistula (PF) after pancreatoduodenectomy (PD) represents the major source of morbidity. Derivative procedures are preferred by pancreatic surgeons, but the optimal management of remnant pancreatic stump remains controversial. Aims The purpose of this retrospective study is to evaluate the efficacy and safety of pancreatic stump closure in selected elderly patients (> 65 years). Methods Clinical data of 44 PD undergone mechanical closure of the pancreatic stump performed between 2001 and 2014 in two department of general and oncologic surgery were retrospectively collected. Considering the age, patients were divided into two groups: 21 patients of less than 65 years (Group A) and 23 patients of more than 65 years (Group B). Results A soft pancreatic parenchyma with a not-dilated duct (diameter < 3 mm) was reported in all the 44 patients. A grade-A PF, which did not required further treatments, developed in 20 cases (45.4%; 13 in group A and 7 in group B; p < 0.05), grade-B in 5 patients (11.4%; 3 in group A and 2 in group B; statistically not significant) and a grade-C PF was observed only in one patient (2.2%; 1 in group A and 0 in group B). Discussion In selected "high risk'' elderly patients (> 65 years) with soft pancreatic texture, the closure of the pancreatic stump can be a useful tool in the surgical armamentarium with the aim to reduce the incidence of age-related complications. Conclusions Prospective randomized controlled trial to better evaluate PF risk factors is needed.