Management of adenocarcinoma of the pancreatic tail in the elderly.
Publication/Presentation Date
3-1-2023
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.
Volume
127
Issue
3
First Page
405
Last Page
412
ISSN
1096-9098
Published In/Presented At
Boutros, C. S., Hue, J. J., Elshami, M., Rothermel, L. D., Hoehn, R. S., Ammori, J. B., Winter, J. M., Ocuin, L. M., & Hardacre, J. M. (2023). Management of adenocarcinoma of the pancreatic tail in the elderly. Journal of surgical oncology, 127(3), 405–412. https://doi.org/10.1002/jso.27134
Disciplines
Medicine and Health Sciences
PubMedID
36301227
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article
