Survival and Perioperative Outcomes Following Pancreatic Surgery in Super-Elderly (Aged ≥85 Years) Pancreatic Ductal Adenocarcinoma Patients

Introduction: The number of elderly pancreatic ductal adenocarcinoma (PDAC) patients is increasing worldwide. However, perioperative outcomes and postoperative survival of pancreatic surgery for super-elderly (aged ≥85 years) PDAC patients have not been entirely clarified. Here, we investigated the short-/long- term outcomes of pancreatic surgery for super-elderly PDAC patients. Methods: In our hospital, 134 consecutive PDAC patients underwent pancreatoduodenectomy (PD, n=76) or distal pancreatomy (DP, n=58) between 2009 and 2020. The relationships between age (≥85/<85 years) and short-/long- term outcomes were retrospectively analyzed. Results: Pancreatic surgery for ≥85 PDAC patients was performed in the 4/76 PD and 4/58 DP groups. Clinical-pathological properties and perioperative factors including hospital stay duration were comparable between ≥85 and <85 cases in both groups. In the PD group, the frequency of ISPGF grade B pancreatic fistula was low in both ≥85 (0/4) and <85 (4/72) cases (P=1.00). In the DP group, ISPGF grade B was occurred in ≥85 (2/4) and <85 (11/54) cases (P=0.17). No ISPGF grade C was observed in both groups. Survival analyses resulted that no significant differences of recurrence-free survival (RFS) and overall survival (OS) were confirmed between ≥85 and <85 cases in the PD and DP groups. In the whole cohort (n=134), RFS (median 12.5 vs 18.0 months, P=0.784) and OS (median 36.8 vs 38.3 months, P=0.964) were also comparable between ≥85 and <85 cases. Conclusion: This retrospective cohort study suggests that pancreatic surgery for super-elderly PDAC patients is feasible, and achieve comparable long-term outcomes to <85 years PDAC patients.