title: Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality.
abstract: OBJECTIVE
  To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection.
  
  
  METHODS
  Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005).
  
  
  METHODS
  Secondary data analysis of population-based tumor registry and linked claims data.
  
  
  METHODS
  Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship.
  
  
  METHODS
  Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group.
  
  
  RESULTS
  Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001).
  
  
  CONCLUSIONS
  With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.
authors: Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA. tsriall@utmb.edu
authors: Taylor S
authors: TS
authors: Riall
authors: Kristin M
authors: KM
authors: Sheffield
authors: Yong-Fang
authors: YF
authors: Kuo
authors: Courtney M
authors: CM
authors: Townsend
authors: James S
authors: JS
authors: Goodwin
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology