Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality

Abstract

Objectives: To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection.

Design: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005).

Setting: Secondary data analysis of population-based tumor registry and linked claims data.

Participants: Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship.

Measurements: Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group.

Results: Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001).

Conclusion: With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.

Figure 1

Time trends in rates of (A) surgical resection and (B) 30-day mortality after surgical resection from 1992–1996 to 2002–2005 for the overall cohort and acdording to age group. Surveillance, Epidemiology, and End Results–Medicare linked data.

Figure 2

Unadjusted Kaplan-Meier survival curves showing all-cause mortality over 2 years of follow-up according to (A) surgical resection status, (B) age group, and (C) age group after surgical resection and (D) pancreatic cancer–specific mortality through 2005 according to age group after surgical resection. Surveillance, Epidemiology, and End Results–Medicare linked data.