Survival after Pancreatic Resection in Older Patients with Pancreatic Malignancy

Abstract

Introduction: Pancreatic malignancies have among the highest mortality rates of solid organ cancers, and there has been a global trend towards an increasing incidence. In the context of an aging population, more older patients will present for consideration of curative resection. Although mortality and morbidity associated with pancreatic resection has improved, there are mixed outcomes reported in the literature regarding survival outcomes for older patients undergoing pancreatectomy. Methods: A retrospective cohort study was performed including patients ≥75 years of age undergoing pancreatic resection for primary pancreatic malignancy, identified using a prospectively maintained database of a single surgeon’s experience. The primary outcomes were median survival and 5-year overall survival. Secondary outcomes included hospital length of stay, peri-operative morbidity and mortality, patterns of recurrence and disease-free survival. Results: 41 patients aged ≥75 years were identified from a total of 497 major pancreatic resections for malignancy between 2007 and 2020. The mean age was 80.6 (range 75 - 88) Of these patients, patients underwent pancreacitoduodectomy (n=36), distal pancreatectomy (n=3), total pancreatectomy (n=2) for pancreatic adenocarcinoma (n=34), ampullary adenocarcinoma (n=5), pancreatic acinar carcinoma (n=1) and invasive microcystic cystadenoma (n=1). 21 patients (51%) had concurrent major vascular resection. The median survival was 24 months, and the 5-year overall survival rate 37%. 30-day and 90-day mortality was 0% and 4.9% (n=2), respectively. Conclusion: Pancreatic resection for malignancy in appropriately selected older adults is safe and confers comparable survival outcomes to the general population. Age alone should not be a contraindication to pancreatectomy.