Long‐Term Outcomes After Pancreatectomy for Pancreatic Ductal Adenocarcinoma in Elderly Patients: Special Reference to Postoperative Adjuvant Chemotherapy

Watanabe, Yusuke; Shinkawa, Tomohiko; Endo, Shunsuke; Abe, Yuji; Nishihara, Kazuyoshi; Nakano, Toru

doi:10.1007/s00268-018-4496-y

Cited by 7 publications

(13 citation statements)

References 51 publications

(65 reference statements)

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“…Previous studies on OS in elderly reported no statistically significant difference between older and younger patients (median 9–26 vs. 12–24 months), and age was not independently associated with OS in multivariable analysis. 8 , 15 , 19 , 24 , 31 Moreover, DFS was comparable between both age groups (median 7–13 vs. 15 months). 19 , 53 Our results show significant differences in median OS and DFS for patients aged ≥ 75 years when compared with patients aged <75 years, i.e.…”

Section: Discussionmentioning

confidence: 84%

“… 8 , 15 , 19 , 24 , 31 Moreover, DFS was comparable between both age groups (median 7–13 vs. 15 months). 19 , 53 Our results show significant differences in median OS and DFS for patients aged ≥ 75 years when compared with patients aged <75 years, i.e. 15 versus 21 months ( p < 0.001) and 12 versus 16 months ( p < 0.001).…”

Section: Discussionmentioning

confidence: 84%

“…Most of the studies reporting on elderly are performed in selected patients from single-center studies with small study groups, and the representativeness of these outcomes in a general population can be questioned. 8 , 14 , 15 , 19 , 22 , 24 – 26 , 28 – 31 Furthermore, the direct impact of age as an independent predictor for short-term postsurgical outcomes remains controversial. 8 , 22 – 27 In the current study, the rates of major complications and 90-day mortality were lower compared with previous studies, and not significantly different between both age groups.…”

Section: Discussionmentioning

confidence: 99%

“…3,[14][15][16][17][18] It has also been shown that older patients may be less likely to receive adjuvant chemotherapy due to frailty, even though chemotherapy is associated with improved survival. [19][20][21] However, the independent impact of age on clinical outcomes remains controversial. 8,[22][23][24][25][26][27] Furthermore, most previous studies on pancreatic surgery in the elderly were performed in selected patients from single-center studies with small study populations and without correction for frailty.…”

mentioning

confidence: 99%

“…8,[22][23][24][25][26][27] Furthermore, most previous studies on pancreatic surgery in the elderly were performed in selected patients from single-center studies with small study populations and without correction for frailty. 8,14,15,19,22,[24][25][26][28][29][30][31] A reflection of daily clinical practice in terms of short-and long-term outcomes of elderly patients after resection for pancreatic cancer on a nationwide scale is lacking.…”

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confidence: 99%

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Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

et al. 2022

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Surgery/Interventions in the Elderly Patient with Pancreatic Cancer

Chesney

Menjak

Myrehaug

et al. 2021

Textbook of Pancreatic Cancer

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Pancreatic resections in elderly patients with high American Society of Anesthesiologists’ risk score: a view from a tertiary care center

et al. 2019

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Background More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases. Aim To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk. Methods A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. Results Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients. Conclusions Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.

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Long‐Term Outcomes After Pancreatectomy for Pancreatic Ductal Adenocarcinoma in Elderly Patients: Special Reference to Postoperative Adjuvant Chemotherapy

Abstract: The benefit of pancreatectomy for PDAC was the same between young and elderly patients. Completion of planned AC was important, and lowered-dose AC using S1 for elderly patients might be safe and therapeutically useful.

Cited by 7 publications

References 51 publications

Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

Surgery/Interventions in the Elderly Patient with Pancreatic Cancer

Pancreatic resections in elderly patients with high American Society of Anesthesiologists’ risk score: a view from a tertiary care center

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