Management of adenocarcinoma of the pancreatic tail in the elderly. Issue 3 (27th October 2022)

• Record Type: Journal Article
• Authors: Boutros, Christina S.; Hue, Jonathan J.; Elshami, Mohamedraed; Rothermel, Luke D.; Hoehn, Richard S.; Ammori, John B.; Winter, Jordan M.; Ocuin, Lee M.; Hardacre, Jeffrey M.
• Is Part Of: Journal of surgical oncology. Volume 127:Issue 3(2023)
• Page Start: 405
• Page End: 412
• Publication Date: 2022-10-27
• Subjects: elderly -- pancreatic cancer -- survival analysis; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.27134
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Introduction: Elderly patients with adenocarcinoma of the pancreatic head can achieve reasonable survival with multimodal therapy. An analysis specific to cancers of the pancreatic tail has not been published. Methods: We identified patients ≥65 years with localized adenocarcinoma of the pancreatic tail in the National Cancer Database (2011–2017). Patients were grouped by age (65–79 and ≥80 years) and categorized by treatment regimen. Postoperative outcomes and survival were analyzed using propensity score matching and multivariable logistical regression. Results: 2168 patients were included: 73.9% were 65–79 years and 26.1% were ≥80 years. 34.1% of octogenarians did not receive any treatment, relative to 15.9% of younger patients ( p < 0.001). Thirty‐day mortality rates were similar in operatively managed patients; however, the 90‐day mortality rate among octogenarians was greater (3.0% vs. 7.8%, p < 0.001; odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.07‐3.19). Age ≥ 80 was not associated with survival on multivariable hazards regression (hazard ratio [HR] = 1.08, 95% CI = 0.95–1.24). After propensity matching, the addition of chemotherapy was not associated with improved survival relative to distal pancreatectomy alone among octogenarians (HR = 1.09, 95% CI = 0.72–1.65). Conclusions: Management of adenocarcinoma of the pancreatic tail varies based on patient age. Resection appears to play a key role in management, but there is substantial upfront risk. Shared decision making should be employed to balance the chance for long‐term survival with the risk of early mortality.