Abstract
Due to increasing life expectancy and improved diagnostic sensitivity, a growing number of older patients are presenting with resectable pancreatic disease entities and are being evaluated for surgery. Intended as an internal quality control for patient selection, we aimed at evaluating septuagenarians and octogenarians compared with patients younger than 70 years of age regarding early postoperative outcome in general, and long-term oncologic outcome in the case of resection for pancreatic adenocarcinoma. A total number of 1231 patients who underwent pancreatic resection for any entity between 2007 and 2019 at our tertiary university medical center in Germany were retrospectively analyzed, accessing a prospectively maintained database. Participants were divided into three groups based on age (<70 years: N = 761; 70–79 years: N = 385; 80–89 years: N = 85) and were evaluated with regard to perioperative variables, postoperative morbidity, mortality and overall survival for the subgroup of patients with pancreatic adenocarcinoma. Pancreatic resection in older individuals was not infrequent. When surgery was performed for carcinoma, patients >70 years of age even constituted almost half of the cases. In spite of increased American Society of Anesthesiologists physical status classification (ASA)-scores and more frequent comorbidities in older patients, similar rates for postoperative morbidity and mortality were observed in all age groups. A significant disparity in the use of (neo-) adjuvant therapy between younger and older pancreatic adenocarcinoma patients was detected. However, median overall survival did not significantly differ between all age groups (<70 years: 28 (95%-CI: 22–34) months; 70–79 years: 21 (17–25) months; 80–89 years: 15 (9–21) months). In conclusion, elderly patients can experience similar perioperative outcomes to those of younger individuals after major pancreatic surgery. The survival benefit from resection of localized pancreatic adenocarcinoma is largely independent of patient age. The results are reassuring with respect to our preoperative practice and clinical judgment regarding careful patient selection. Future randomized trials should decidedly include elderly patients to generate more robust evidence to further optimize treatment recommendation and choice.
Highlights
Pancreatic surgery followed by adjuvant chemotherapy is the only potential cure for pancreatic cancer and is central in the therapy of carcinomas of the distal bile duct, ampulla of vater and duodenum
From January 2007 to April 2019, a total number of 1231 pancreatic resections were performed in our institution for primary pancreato-duodenal and distal bile duct disease entities, including pancreatic metastasis and rare cases of emergency pancreatic procedures
A small number of lateral longitudinal pancreaticojejunostomies according to Partington-Rochelle or Frey [18,19] were performed, most of them in younger patients (Table 1)
Summary
In 2015, there were more than 600 million people aged 65 or over, representing about 8% of the global population. This group is projected to double and comprise. Pancreatic surgery followed by adjuvant chemotherapy is the only potential cure for pancreatic cancer and is central in the therapy of carcinomas of the distal bile duct, ampulla of vater and duodenum. It is the sole treatment option for cystic neoplasms suspicious for the development of malignancy, such as intraductal papillary mucinous neoplasms (IPMN) or mucinous cystic neoplasms (MCN) [5]. Patient selection is critical here, since older individuals more frequently present with relevant comorbidities and frailty, putting them at risk for postoperative complications, mortality, loss of self-reliance and low quality of life [7,8]
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