Pancreatic surgery is safe in elderly patients with PDAC

In an aging society, more and more elderly people are diagnosed with pancreatic ductal adenocarcinoma (PDAC), unfortunately, many of these patients didn't receive proper treatment compared to their younger counterparts. The safety of surgical intervention in elderly pancreatic cancer patients remains a subject of ongoing debate.

We retrospectively analyzed PDAC patients who underwent radical resection between 2012 and 2021 at Zhongshan Hospital, Fudan University. Patients were categorized into two groups: non-elderly (< 70 years) and elderly (≥ 70 years). We compared operation-related factors and postoperative complications between the two groups. Additionally, subgroup analysis was conducted to assess the impact of inflammatory-nutritional status on both elderly and non-elderly patients.

A total of 892 pancreatic cancer patients who underwent radical resection were included, consisting of 256 elderly and 636 non-elderly patients. Our study revealed that elderly pancreatic cancer patients had an earlier 8th edition American Joint Committee on Cancer (AJCC) T stage (T3 + T4, 10.6% vs. 18.7%) and N stage (N0, 68.2% vs. 55.2%), a higher American Society of Anesthesiologists (ASA) grade (grade 2 + grade 3, 92.6% vs. 87.7%), lower inflammatory markers (lymphocyte count and lymphocyte to monocyte ratio) and poorer nutritional status (total protein, albumin, prealbumin, hemoglobin, transferrin, platelet). The incidence of postoperative complications including reoperation, postoperative pancreatic fistula, pulmonary embolism, surgical site infection and post-pancreatectomy hemorrhage, was comparable between the two groups, except for delayed gastric emptying (16.4% vs. 22.8%, p = 0.0360). Furthermore, poorer inflammatory-nutritional status was frequently associated with more complex surgical procedures, including longer surgical durations, greater intraoperative reported blood loss, and a higher number of resected lymph nodes, particularly in non-elderly patients.

With comprehensive preoperative evaluation and careful postoperative care, pancreatic surgery is safe for elderly patients in experienced pancreatic cancer centers.