title: Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands.
abstract: BACKGROUND
  At a national level, it is unknown to what degree elderly patients with pancreatic or periampullary carcinoma benefit from surgical treatment compared to their younger counterparts. We investigated resection rates and outcomes after surgical treatment among elderly patients.
  
  
  METHODS
  From the Netherlands Cancer Registry, 20 005 patients diagnosed with primary pancreatic or periampullary cancer in 2005-2013 were selected. The associations between age (<70, 70-74, 75-79, ≥80 years) and resection rates were investigated using χ(2) tests, and surgical outcomes (30-, 90-day mortality) were evaluated using logistic regression analysis. Overall survival after resection was investigated by means of Kaplan-Meier and Cox proportional hazard regression analysis.
  
  
  RESULTS
  During the study period, resection rates increased in all age groups (<70 years: 20-30%, p < 0.001; ≥80 years: 2-8%, p < 0.001). Of 3845 patients who underwent tumour resection for pancreatic or periampullary carcinoma, the proportion of octogenarians increased from 3.5% to 5.5% (p = 0.03), whereas postoperative mortality did not increase (30-day: 6-3%, p = 0.06; 90-day: 9-8%, p = 0.21). With rising age, 30-day postoperative mortality increased (4-5-7-8%, respectively, p < 0.001), while 90-day mortality was 6-10-13-12% (p < 0.001) and three-year overall survival rates after surgery were 35-33-28-31%, respectively (p < 0.001). After adjustment for confounding factors, octogenarians who survived 90 days postoperative exhibited an overall survival close to younger patients [hazard ratio (≥80 vs. <70 years) = 1.21, 95% confidence interval (0.99-1.47), p = 0.07].
  
  
  CONCLUSIONS
  Despite higher short-term mortality, octogenarians who underwent pancreatic resection showed long-term survival similar to younger patients. With careful patient screening and counselling of elderly patients, a further increase of resection rates may be combined with improved outcomes.
authors.affiliation: a Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Utrecht , The Netherlands.
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
authors.affiliation: b Department of Surgery , Academic Medical Center AMC , Amsterdam , The Netherlands.
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: a Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Utrecht , The Netherlands.
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.affiliation: b Department of Surgery , Academic Medical Center AMC , Amsterdam , The Netherlands.
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.affiliation: c Department of Surgery , Catharina Hospital , Eindhoven , The Netherlands.
authors.forename: Ignace H J T
authors.initials: IH
authors.lastname: de Hingh
authors.affiliation: d Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation , University Medical Center Groningen , Groningen , The Netherlands.
authors.forename: Koert P
authors.initials: KP
authors.lastname: de Jong
authors.affiliation: e Department of Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.
authors.forename: I Quintus
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: a Department of Research , Netherlands Comprehensive Cancer Organisation (IKNL) , Utrecht , The Netherlands.|f Department of Public Health , Erasmus MC University Medical Center , Rotterdam , The Netherlands.
authors.forename: Valery E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult