Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis
Anne Claire Henry, Thijs J. Schouten, Lois A. Daamen, Marieke S. Walma, Peter G. Noordzij, Geert A. Cirkel, Maartje Los, Marc G. Besselink, Olivier R. Busch, Bert A. Bonsing, Koop Bosscha, Ronald M. van Dam, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Ignace H. J. T. de Hingh, Geert Kazemier, Mike S.L. Liem, Vincent E. de Meijer, Vincent B. Nieuwenhuijs, Daphne Roos, Jennifer M. J. Schreinemakers, Martijn W.J. Stommel, I. Quintus Molenaar, Hjalmar C. van Santvoort, for the Dutch Pancreatic Cancer Group
Abstract
BACKGROUND: The number of elderly patients with pancreatic cancer is growing, however clinical data on the short-term outcomes, rate of adjuvant chemotherapy, and survival in these patients are limited and we therefore performed a nationwide analysis. METHODS: Data from the prospective Dutch Pancreatic Cancer Audit were analyzed, including all patients undergoing pancreatic cancer resection between January 2014 and December 2016. Patients were classified into two age groups: <75 and ≥75 years. Major complications (Clavien-Dindo grade 3 or higher), 90-day mortality, rates of adjuvant chemotherapy, and survival were compared between age groups. Factors associated with start of adjuvant chemotherapy and survival were evaluated with logistic regression and multivariable Cox regression analysis. RESULTS: Of 836 patients, 198 were aged ≥75 years (24%) and 638 were aged <75 years (76%). Median follow-up was 38 months (interquartile range [IQR] 31-47). Major complications (31% vs. 28%; p = 0.43) and 90-day mortality (8% vs. 5%; p = 0.18) did not differ. Adjuvant chemotherapy was started in 37% of patients aged ≥75 years versus 69% of patients aged <75 years (p < 0.001). Median overall survival (OS) was 15 months (95% confidence interval [CI] 14-18) versus 21 months (95% CI 19-24; p < 0.001). Age ≥75 years was not independently associated with OS (hazard ratio 0.96, 95% CI 0.79-1.17; p = 0.71), but was associated with a lower rate of adjuvant chemotherapy (odds ratio 0.27, 95% CI 0.18-0.40; p < 0.001). CONCLUSIONS: The rate of major complications and 90-day mortality after pancreatic resection did not differ between elderly and younger patients; however, elderly patients were less often treated with adjuvant chemotherapy and their OS was shorter.