title: Pancreatic cancer: surgery is a feasible therapeutic option for elderly patients.
abstract: BACKGROUND
  Compromised physiological reserve, comorbidities, and the natural history of pancreatic cancer may deny pancreatic resection from elderly patients. We evaluated outcomes of elderly patients amenable to pancreatic surgery.
  
  
  METHODS
  The medical records of all patients who underwent pancreatic resection at our institution (1995-2007) were retrospectively reviewed. Patient, tumor, and outcomes characteristics in elderly patients aged ≥ 70 years were compared to a younger cohort (<70 y).
  
  
  RESULTS
  Of 460 patients who had surgery for pancreatic neoplasm, 166 (36%) aged ≥ 70 y. Compared to patients < 70 y (n = 294), elderly patients had more associated comorbidities; 72% vs. 43% (p = 0.01) and a higher rate of malignant pathologies; 73% vs. 59% (p = 0.002). Operative time and blood products consumption were comparable; however, elderly patients had more post-operative complications (41% vs. 29%; p = 0.01), longer hospital stay (26.2 vs. 19.7 days; p < 0.0001), and a higher incidence of peri-operative mortality (5.4% vs. 1.4%; p = 0.01). Multivariable analysis identified age ≥ 70 y as an independent predictor of shorter disease-specific survival (DSS) among patients who had surgery for pancreatic adenocarcinoma (n = 224). Median DSS for patients aged ≥ 70 y vs. < 70 y were 15 months (SE: 1.6) vs. 20 months (SE: 3.4), respectively (p = 0.05). One, two, and 5-Y DSS rates for the cohort of elderly patients were 58%, 36% and 23%, respectively.
  
  
  CONCLUSIONS
  Properly selected elderly patients can undergo pancreatic resection with acceptable post-operative morbidity and mortality rates. Long term survival is achievable even in the presence of adenocarcinoma and therefore surgery should be seriously considered in these patients.
authors.affiliation: Department of Surgery at The Sourasky Medical, Tel-Aviv, Israel. guyla@tasmc.health.gov.il
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.forename: Ronen
authors.initials: R
authors.lastname: Sever
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.forename: Ido
authors.initials: I
authors.lastname: Nachmany
authors.forename: Fabian
authors.initials: F
authors.lastname: Gerstenhaber
authors.forename: Menahem
authors.initials: M
authors.lastname: Ben-Haim
authors.forename: Richard
authors.initials: R
authors.lastname: Nakache
authors.forename: Josef
authors.initials: J
authors.lastname: Koriansky
authors.forename: Josef M
authors.initials: JM
authors.lastname: Klausner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome