Postoperative and long-term survival in relation to life-expectancy after pancreatic surgery in elderly patients (cohort study)

Abstract

Background An evaluation of the outcome after pancreatic surgery with focus on post-operative and late survival in elderly patients was performed. Methods The study included 1.556 patients from a single HBP unit operated from 1. January 2010 to 31. December 2019. Patients were divided into two cohorts, < 75 years ( n = 1.296) and ≥75 years ( n = 260). Post-operative outcome was evaluated in all patients and late outcome in patients with adenocarcinoma in the pancreas ( n = 765) and the duodenum ( n = 117). The follow-up of patients with benign disease and adenocarcinoma was 57.95 (12.1–132.7) and 39.85 (12.0–131.7) months, respectively. Results Length of hospital-stay and surgical complications were not significantly different in the two cohorts, but in-hospital death was 1.1% (<75 years) and 3.5% (≥75 years) ( p = 0.008). The median overall survival of adenocarcinoma was 29.7 (<75 years) and 24.3 months (≥75 years) ( p = 0.3228) with a one, two, and five-years survival of 74.5%, 56.6% and 28.6% vs. 73.6%, 51.1%, and 25.5%. Median time to relapse (46.2% of patients <75 years and 40.5% of patients ≥75 years) was 9 (1 - 51) and 8 (1 - 78) months (p = 0.534), respectively. Adjuvant chemotherapy did not have impact on the survival of the old cohort. Patients who died during the observation period had lost 94% (<75 years) and 87% (≥75 years) of expected remnant life. Estimated years lost in the old cohort was 4.2 in males and 4.9 in females ( p = 0.025) Conclusion Elderly patients may undergo pancreatic surgery with a low mortality and for adenocarcinoma with an acceptable long-term survival.

Oncological outcomes after pancreatoduodenectomy for pancreatic ductal adenocarcinoma in octogenarians: case-control study

“…Furthermore, even if this is achieved, doubt still rests in any oncological benefit that may be produced in respect to the patients’ life expectancy in the 9th decade of their life. The elderly are at a higher risk of mortality from both non-PDAC cancers and non-cancer-related causes 21 , 22 . Therefore, the propriety of curative treatment needs to take the patient's remnant life expectancy, as well as quality of life, into consideration 23 .…”

“…The fact that elderly patients are in general less likely to receive any systemic treatment has been documented by various studies 45 (possibly due to the concerns regarding tolerability of multiagent regimens), even though evidence supports their safety and efficacy resulting in comparable survival to younger cohorts 8 , 46 , 47 . Elderly patients are more likely to receive reduced doses of adjuvant chemotherapy and only in the presence of lymph-node-positive disease 40 , a treatment selection bias which is not present in younger patients 22 .…”