Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

Abstract

Background: At a national level, it is unknown to what degree elderly patients with pancreatic or periampullary carcinoma benefit from surgical treatment compared to their younger counterparts. We investigated resection rates and outcomes after surgical treatment among elderly patients. Methods: From the Netherlands Cancer Registry, 20 005 patients diagnosed with primary pancreatic or periampullary cancer in 2005-2013 were selected. The associations between age (570, 70-74, 75-79, 80 years) and resection rates were investigated using 2 tests, and surgical outcomes (30-, 90-day mortality) were evaluated using logistic regression analysis. Overall survival after resection was investigated by means of Kaplan-Meier and Cox proportional hazard regression analysis. Results: During the study period, resection rates increased in all age groups (570 years: 20-30%, p50.001; 80 years: 2-8%, p50.001). Of 3845 patients who underwent tumour resection for pancreatic or periampullary carcinoma, the proportion of octogenarians increased from 3.5% to 5.5% (p ¼ 0.03), whereas postoperative mortality did not increase (30-day: 6-3%, p ¼ 0.06; 90-day: 9-8%, p ¼ 0.21). With rising age, 30-day postoperative mortality increased (4-5-7-8%, respectively, p50.001), while 90-day mortality was 6-10-13-12% (p50.001) and three-year overall survival rates after surgery were 35-33-28-31%, respectively (p50.001). After adjustment for confounding factors, octogenarians who survived 90 days postoperative exhibited an overall survival close to younger patients [hazard ratio (80 vs.570 years) ¼ 1.21, 95% confidence interval (0.99-1.47), p ¼ 0.07]. Conclusion: Despite higher short-term mortality, octogenarians who underwent pancreatic resection showed long-term survival similar to younger patients. With careful patient screening and counselling of elderly patients, a further increase of resection rates may be combined with improved outcomes.

Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations

“…Centralisation could contribute to increases in resection rates 17. Centralisation started in the Netherlands regionally in 200518 19 and nationally in 2011,20 and in Denmark in 200021. Nationally, the number of hospitals performing pancreatoduodenectomy for PaC decreased from 39 to 23 in 2004 to 2009 in the Netherlands and the proportion of patients resected at medium/high-volume (>10 resections/year) centres increased from 53% to 91%, accompanied by an increase in pancreatoduodenectomy from 258 (11%) to 394 (18%) 17 22.…”

Pancreatic resection in very elderly patients: A critical analysis of existing evidence

“…Given the role of adjuvant therapies in prolonging overall survival and delaying time to recurrence in resectable pancreatic cancer[34,35], the advancing age alone should not preclude the use of adjuvant treatment. Although these limitations, most Authors reported that overall survival after resection for pancreatic cancer in octogenarians is not statistically different from younger patients[18,21,36,37]. …”

The Impact of Socioeconomic Status, Surgical Resection and Type of Hospital on Survival in Patients with Pancreatic Cancer. A Population-Based Study in The Netherlands

“…Thus, we extrapolate that postoperative mortality and SES are not predictors of cancer survival. [41]…”