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. 2022 Sep;29(9):6031-6042.
doi: 10.1245/s10434-022-11831-7. Epub 2022 Jun 2.

Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

Anne Claire Henry  1 , Thijs J Schouten  1 , Lois A Daamen  1 , Marieke S Walma  1 , Peter Noordzij  2 , Geert A Cirkel  3 , Maartje Los  4 , Marc G Besselink  5 , Olivier R Busch  5 , Bert A Bonsing  6 , Koop Bosscha  7 , Ronald M van Dam  8 , Sebastiaan Festen  9 , Bas Groot Koerkamp  10 , Erwin van der Harst  11 , Ignace H J T de Hingh  12 , Geert Kazemier  13 , Mike S Liem  14 , Vincent E de Meijer  15 , Vincent B Nieuwenhuijs  16 , Daphne Roos  17 , Jennifer M J Schreinemakers  18 , Martijn W J Stommel  19 , I Quintus Molenaar #  1 , Hjalmar C van Santvoort #  20 ; Dutch Pancreatic Cancer Group
Affiliations

Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

Anne Claire Henry et al. Ann Surg Oncol. 2022 Sep.

Abstract

Background: The number of elderly patients with pancreatic cancer is growing, however clinical data on the short-term outcomes, rate of adjuvant chemotherapy, and survival in these patients are limited and we therefore performed a nationwide analysis.

Methods: Data from the prospective Dutch Pancreatic Cancer Audit were analyzed, including all patients undergoing pancreatic cancer resection between January 2014 and December 2016. Patients were classified into two age groups: <75 and ≥75 years. Major complications (Clavien-Dindo grade 3 or higher), 90-day mortality, rates of adjuvant chemotherapy, and survival were compared between age groups. Factors associated with start of adjuvant chemotherapy and survival were evaluated with logistic regression and multivariable Cox regression analysis.

Results: Of 836 patients, 198 were aged ≥75 years (24%) and 638 were aged <75 years (76%). Median follow-up was 38 months (interquartile range [IQR] 31-47). Major complications (31% vs. 28%; p = 0.43) and 90-day mortality (8% vs. 5%; p = 0.18) did not differ. Adjuvant chemotherapy was started in 37% of patients aged ≥75 years versus 69% of patients aged <75 years (p < 0.001). Median overall survival (OS) was 15 months (95% confidence interval [CI] 14-18) versus 21 months (95% CI 19-24; p < 0.001). Age ≥75 years was not independently associated with OS (hazard ratio 0.96, 95% CI 0.79-1.17; p = 0.71), but was associated with a lower rate of adjuvant chemotherapy (odds ratio 0.27, 95% CI 0.18-0.40; p < 0.001).

Conclusions: The rate of major complications and 90-day mortality after pancreatic resection did not differ between elderly and younger patients; however, elderly patients were less often treated with adjuvant chemotherapy and their OS was shorter.

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Conflict of interest statement

Anne Claire Henry, Thijs J. Schouten, Lois A. Daamen, Marieke S. Walma, Peter Noordzij, Geert A. Cirkel, Maartje Los, Marc G. Besselink, Olivier R. Busch, Bert A. Bonsing, Koop Bosscha, Ronald M. van Dam, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Ignace H.J.T. de Hingh, Geert Kazemier, Mike S. Liem, Vincent E. de Meijer, Vincent B. Nieuwenhuijs, Daphne Roos, Jennifer M.J. Schreinemakers, Martijn W.J. Stommel, I. Quintus Molenaar, and Hjalmar C. van Santvoort have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Overall survival of 638 patients aged < 75 years and 198 patients aged ≥ 75 years after resection for pancreatic cancer
Fig. 2
Fig. 2
Disease-free survival of 638 patients aged < 75 years and 198 patients aged ≥ 75 years after resection for pancreatic cancer
Fig. 3
Fig. 3
Overall survival in 71 patients aged ≥ 75 years and in 429 patients aged < 75 years after resection for adjuvant chemotherapy
Fig. 4
Fig. 4
Disease-free survival in 71 patients aged ≥ 75 years and in 429 patients aged < 75 years after resection for adjuvant chemotherapy
See this image and copyright information in PMC

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