Octogenarians and Pancreatic Cancer: Is Surgery Always the Right Choice?

Area of Science:

• Oncology
• Geriatric Medicine
• Surgical Oncology

Background:

• Pancreatic ductal adenocarcinoma (PDAC) incidence is rising in octogenarians due to demographic shifts.
• Surgery is a cornerstone of PDAC treatment, but its benefits and risks in the elderly are debated.
• Increasing numbers of elderly patients necessitate evaluating treatment efficacy in this demographic.

Purpose of the Study:

• To assess the benefits and outcomes of surgical intervention for pancreatic ductal adenocarcinoma (PDAC) in octogenarian patients.
• To compare treatment patterns and survival rates across different age groups undergoing PDAC treatment.
• To identify potential strategies for optimizing care for elderly PDAC patients.

Main Methods:

• Retrospective analysis of PDAC patient data from 2015-2023, stratified into three age groups: ≤65, 66-79, and ≥80 years.
• Comparison of demographic, histopathological, treatment, and survival data across age cohorts.
• Evaluation of surgical intervention, chemotherapy use, and 90-day mortality rates.

Main Results:

• The proportion of octogenarian PDAC patients increased significantly from 15% in 2015 to 32% in 2023.
• Octogenarians, despite more favorable tumor stages, received palliative chemotherapy more often and adjuvant chemotherapy less frequently after surgery (24%).
• Octogenarians exhibited worse overall survival, disease-free survival, and higher 90-day mortality compared to younger groups; surgery or curative chemotherapy alone yielded outcomes similar to palliative care.

Conclusions:

• Surgery alone provides limited benefit for octogenarian patients with pancreatic ductal adenocarcinoma (PDAC).
• The low rate of adjuvant chemotherapy post-surgery in octogenarians suggests a need for better patient selection.
• Neoadjuvant treatment approaches could be valuable for identifying elderly patients who can benefit from comprehensive multimodal PDAC therapy.