title: Potential role of surgical resection for pancreatic cancer in the very elderly.
abstract: BACKGROUND
  There is increasing need to evaluate the surgical indication of pancreatic cancer in very elderly patients. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of pancreatic resection in pancreatic cancer patients over the age of 80.
  
  
  METHODS
  Between 2005 and 2012, 26 octogenarian patients who received pancreatic resection and 20 who received chemotherapy for pancreatic cancer were retrospectively reviewed. Clinicopathological factors, chemotherapy administration status, and survival were compared. Univariate and multivariate analysis of prognostic factors for survival was performed.
  
  
  RESULTS
  Postoperative major complication rate was 8%, with no mortality. The one-year survival rate and median survival time of the surgery and chemotherapy groups were 50% and 45%, and 12.4 months and 11.7 months, respectively (P = 0.263). Of the 26 resected cases, 6 completed the planned adjuvant chemotherapy treatment course. The median survival time of those 6 completed cases was significantly longer than that of the 20 not completed cases (23.4 versus 10.0 months, P = 0.034). Furthermore, a multivariate analysis of the 26 resected cases showed that distant metastasis (HR 3.206, 95%CI 1.005-10.22, P = 0.049) and completion of the planned adjuvant therapy (HR 4.078, 95%CI 1.162-14.30, P = 0.028) were independent prognostic factors of surgical resection.
  
  
  CONCLUSIONS
  Surgical resection was safe, but not superior to chemotherapy for pancreatic cancer in octogenarians. In the very elderly, only selected patients may benefit from pancreatic resection.
authors.affiliation: Department of Surgery, Nara Medical University, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinoshita
authors.affiliation: Department of Surgery, Nara Medical University, Japan. Electronic address: m-sho@naramed-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.affiliation: Department of Surgery, Nara Medical University, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Akahori
authors.affiliation: Department of Surgery, Nara Medical University, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Nagai
authors.affiliation: Department of Surgery, Nara Medical University, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiwada
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Yamaki
authors.affiliation: Department of Surgery, Nara Prefecture Western Medical Center, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Ikeda
authors.affiliation: Department of Surgery, Kansai Medical University, Japan.
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
authors.affiliation: Department of Surgery, Nara Medical University, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D000367:Age Factors; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010094:Oxonic Acid / Q000627:therapeutic use; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D005641:Tegafur / Q000627:therapeutic use; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine
keywords: Chemotherapy; Elderly; Pancreatectomy; Pancreatic adenocarcinoma; Prognosis; Surgery