A modern era analysis of elderly patients undergoing surgical resection for pancreatic adenocarcinoma- Is it worth the risk?

Presenter: Veronika Lobova BS | Washington State University Background: As the population of the United States continues to age, incidence of pancreatic adenocarcinoma (PDAC) is also expected to increase, making more elderly patients candidates for surgical resection. In patients over 75 years old, however, the risk of pancreatic resection may outweigh the survival benefits. Thus, the primary aim of this study was to evaluate both progression-free and overall survival among PDAC patients over 75 years old and to determine factors associated with survival duration. Methods: A retrospective chart review was conducted for patients older than 75 years old who underwent surgical resection (Whipple surgery and distal pancreatectomy) of PDAC from February 2014 to May 2020 at a single community-based hospital. Clinical parameters, additional treatments, complications, and survival curves were analyzed. Results: A total of 44 patients over the age of 75 years underwent surgical resection of PDAC (median age 79, 48% female). More patients underwent a Whipple procedure compared to distal pancreatectomy (73% vs. 27%, respectively). Fifty-five percent received adjuvant chemotherapy, 18% received neoadjuvant chemotherapy, and 20% had radiation. The median survival for all patients was 9.0 months (quartiles 3.5 - 15.5). Among patients who survived > 3 months (i.e. cancer specific survival) the median survival duration was 12 months (quartiles 8-18 months). Among patients who underwent Whipple surgery and survived there was only one case of progression, and median progression-free survival was 9.0 months (quartiles 4.0-14.0 months). There was no significant difference in survival between Whipple procedures and distal pancreatectomies. Perioperative complications occurred in 32% of patients within 30 days, respectively. Death occurred in 11% of patients within 30 days and 40% of deaths occurred due to cardiac arrest. Survival was significantly longer among patients who had adjuvant chemotherapy or radiation compared to those who did not (median 13.0 vs. 5.0 months, P=0.01, and 18.0 vs. 7.0 months, P=0.002, respectively, see Graph). Survival duration was not different between individuals who received neoadjuvant chemotherapy (median 6.5 months) and those who did not (9.5 months, P=0.45), and did not differ by number of regional nodes involved. Conclusion: The complication rate of surgical resection of PDAC in this elderly population is comparable to the generalized population. However, the mortality rate is higher. More comprehensive preoperative cardiovascular screening may be necessary in the elderly population to prevent cardiovascular related deaths.