HPB P03 Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma

Abstract

Abstract Background Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma Methods A multicentre case-control study of octogenarians matched on complexity of surgery with consecutive younger controls who underwent PD for PDAC (2008–2017). Results Some 220 patients were included, 110 octogenarians (age 81 (80–83)) and 110 controls (age 69 (62–74)). Charlson Comorbidity Index score was higher in octogenarians than controls (7 (6–8) vs 5 (4–6)), p<0.0001) but Eastern Cooperative Oncology Group performance status (Groups 0–1: 99 vs 98; 2–3: 5 vs 4, p=0.756) and ASA (ASA 1–2: 72 vs 77; 3–4: 20 vs 18; p=0.635) were comparable. Adjuvant therapy was delivered more commonly in the younger cohort (76.2 vs 58.0%, p= 0.007). Tumour stage, lymph node ratio and resection margin status were comparable between groups. There was no difference between octogenarians and controls in OS (20 (14–26) vs 29, (24–24) months p=0.095) or DFS (19,(13–24) vs 22,(15–29) months p=0.742). On multivariate analysis, age was not a risk predictor. Conclusions In selected fit octogenarians, equivalent survival is achievable. Centralisation and multimodal therapy are key. Pre-operative risk stratification using at ECOG and albumin level can be used to identify an appropriate population.