Reappraisal of the validity of surgery for patients with pancreatic cancer aged 80 years or older stratified by resectability status

Purpose: The aim of this study was to assess the validity of surgical resection for patients with pancreatic ductal adenocarcinoma (PDAC) aged ≥80 years stratified by resectability status.

Methods: Medical records of 245 patients with resectable (R) and 169 with borderline resectable/unresectable (BR/UR) PDAC were reviewed retrospectively. Of the total of 414 patients, 56 (14%) were ≥80 years. The prognostic impact of age ≥80 years was analyzed with stratification by resectability status.

Results: No significant difference was found in the incidence of major complications between patients aged ≥80 versus <80 years (12% vs. 16% respectively; P = 0.53). However, patients aged ≥80 years were significantly less likely to receive adjuvant gemcitabine + S-1 chemotherapy than those <80 years (39% vs. 83%, respectively; P < 0.001). Multivariate analyses identified age ≥80 years as an independent risk factor for poor survival in the BR/UR group (P = 0.01), whereas it did not affect survival in the R group.

Conclusion: Patients aged ≥80 years had a similar prognosis to <80 years in R PDAC, whereas they had significantly worse prognosis in BR/UR PDAC. These findings suggest that surgical resection for patients with PDAC aged ≥80 years is validated in R PDAC, whereas its survival benefit might be limited in BR/UR PDAC.