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Multicenter Study
. 2025 May;32(5):3582-3592.
doi: 10.1245/s10434-025-16916-7. Epub 2025 Jan 27.

Multimodal Therapy May be Key to Improving Survival for Octogenarians Undergoing Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: An American Multicenter Analysis

Sarah B Hays  1   2 , Kristine Kuchta  3 , Andres A Abreu  4 , Asmita Chopra  5 , Emile Farah  4 , Amudhan Kannan  4 , Syed Abbas Mehdi  3 , Imad Radi  4 , Kristen Ranson  6 , Caroline Rieser  3   7 , Aram E Rojas  3 , Adam Tcharni  5 , Brian A Boone  6 , Alessandro Paniccia  5 , Patricio M Polanco  4 , Carl R Schmidt  6 , Mark S Talamonti  3 , Herbert J Zeh 3rd  4 , Amer H Zureikat  5 , Melissa E Hogg  3
Affiliations
Multicenter Study

Multimodal Therapy May be Key to Improving Survival for Octogenarians Undergoing Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: An American Multicenter Analysis

Sarah B Hays et al. Ann Surg Oncol. 2025 May.

Abstract

Background: As the population ages, the number of octogenarians with pancreatic ductal adenocarcinoma (PDAC) continues to rise. Morbidity and mortality following pancreatectomy have improved owing to safer surgery and better chemoradiation regimens. This study compares the outcomes and multimodality utilization in octogenarians (≥80 years) who underwent pancreaticoduodenectomy (PD) for PDAC, with a younger cohort.

Methods: This is a multi-institutional retrospective review from 2007 to 2023 of patients who underwent PD for PDAC. Preoperative, perioperative, and oncologic outcomes were analyzed, and multivariable analysis (MVA) was performed.

Results: A total of 1,051 patients underwent PD for PDAC ( ≥ 80 = 125, < 80 = 926). Octogenarians had a higher age unadjusted Charlson Comorbidity Index (p = 0.0146) and were more likely to have prior abdominal surgery (p = 0.0019). Patients <80 years received chemotherapy (p < 0.0001) or radiation (p < 0.0001), including neoadjuvant chemotherapy (p < 0.0001), more frequently than octogenarians, who more commonly underwent upfront surgery (p < 0.0001). There were no significant differences in complications. Octogenarians had a higher 90 day mortality rate (7.2% versus 3.5%, p = 0.0424); however, this was not significant on MVA. The <80 cohort had longer overall survival (OS) (p = 0.0004). Receiving any chemotherapy was associated with longer OS (hazard ratio [HR] 0.59 [0.46-0.75], p < 0.0001). In survival analysis of octogenarians only, receiving multimodal therapy significantly prolonged OS compared with surgery alone (p = 0.0349).

Conclusions: Octogenarian status does not increase morbidity or mortality but is associated with decreased survival in PDAC patients undergoing PD. Chemotherapy had a protective effect on OS; however, octogenarians received less multimodal therapy compared with the younger cohort.

Keywords: Multimodal therapy; Neoadjuvant chemotherapy; Octogenarians; Pancreatic ductal adenocarcinoma; Pancreaticoduodenectomy.

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Conflict of interest statement

Disclosure: Dr. Hogg has received funding from Intuitive Surgical, Inc. to the institution for education and training, she serves as a consultant for Olympus Corporation. Dr. Polanco has served as an Intuitive Surgical, Inc. proctor and is a consultant for Medtronic and Iota Biomedical. Dr. Zeh serves on the scientific advisory board for Surgical Safety Technologies. All other authors have no disclosures.

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