Abstract A89: Is it justified to have pancreaticoduodenectomy in elderly patients with pancreatic malignancy? A population-based study

Abstract

Abstract Introduction: Although the perioperative outcome of pancreaticoduodenectomy (PD) has improved in these 10 years, and several studies found the short-term, perioperative outcome is similar between the groups in the elderly or younger patients, the issue of PD on eldely patients is still controversial. Most of the studies were performed in single institute or only reported the short-term outcome. The purpose of this study is to use population-based data to analyze the age effect on perioperative and long-term outcome after PD, esp. in the elderly patients more than 75 years old, and with pancreatic malignancy. Methods: By using the National Health Insurance Research Database (NHIRD) of Taiwan, we performed this nationwide retrospective cohort study. Results: Between 2001-2010, totally, 4475 adult patients (>= 20 years) who received elective PD with ICD procedure code: 52.7 were included. Overall, the 30-day including in-hospital mortality, and 1-year mortality was 5.2%, and 22.9% in younger patients (<= 75 years), and 14.4% and 40% in the elderly (> 75 years). 3639 cases were malignancy, while only 836 cases were benign disease. We further analyzed the data from patients with pancreatic malignancy, elderly patients have significantly longer hospital stay (41.5 days vs 35.9 days), ICU stay and hospital cost after PD. After multivariate analysis, the elderly has significantly higher 30-day mortality (adjusted OR: 2.425 comparing with the younger), and higher 1-year mortality (adjusted OR: 1.867), the age effect on mortality can also be observed as a significant trend (for patients >80, 70-80, 60-70 comparing with <= 60 years: adjusted OR 3.85, 3.50, 2.12). Other factors to predict higher mortality included patients need PRBC transfusion, CCI>2, patients with preoperative comorbidity: myocardia infarction and renal failure. Patients received PD at high volume center (PD >=20 cases / year) have significant less 30-day, and 1-year mortality (adjusted OR: 0.447, and 0.748). Female patients, and operation during the late era, 2006-2010 are the good predictors for less mortality. Furtherly, decision-tree analysis found the old age and operation at high volume center are the most important effects on mortality. Conclusion: Elderly patients (> 75 years) with pancreatic malignancy after pancreaticoduodenectomy have significantly higher 30-day and 1-year mortality. We recommended all elderly patients should be treated at high-volume centers. Citation Format: Ching-Yao Yang, Jin-Ming Wu, Ting-Chun Kuo, Hong-Shiee Lai, Yu-Wen Tien.{Authors}. Is it justified to have pancreaticoduodenectomy in elderly patients with pancreatic malignancy? A population-based study. [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Advances in Science and Clinical Care; 2016 May 12-15; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(24 Suppl):Abstract nr A89.