The Health Gain Obtainable from Pancreatic Resection for Adenocarcinoma in the Elderly.
In treating pancreatic ductal adenocarcinoma (PDAC), age does not represent a contraindication to surgery, even if aging is known to increase postoperative mortality and morbidity. Furthermore, long-term outcome remains poor and there is much debate on whether to operate or not in elderly patients. The aim of this study was to provide a general framework to evaluate the health gain obtainable from surgery for PDAC in relationship with age and tumor stage.



A Monte Carlo simulation model was built taking into consideration pertinent literature from population-based studies regarding surgical and non-surgical outcomes for stages I-II PDAC. The health gain obtainable from surgery, in comparison to the choice of not resecting patients, was measured through number needed-to-treat (NNT) calculation.



Considering the typical stage I-II PDAC characteristics, the model showed that the mean lifespan after surgery was 28.1 ± 3.9 months and 9.3 ± 1.5 months after non-surgical therapies. The NNT with surgery in order to prevent one death at 5 years was 6 (95% CI 4-10), indicating an overall high gain obtainable from surgery. Sensitivity analyses on patient age and tumor stage suggested that starting from 76 years onward, the NNT progressively increases, resulting in a low cure rate of surgery in the elderly and becoming potentially harmful for patients aged above 80 years. These figures were more pronounced for tumor stages IIA and IIB.



The present general framework suggests that the lifespan benefit obtainable from pancreatectomy in elderly patients is uncertain especially with the advancing of the tumor stage.
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy. aleqko@libero.it.|S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy. aleqko@libero.it.
Alessandro
A
Cucchetti
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|Surgical Oncology Unit, General Hospital Morgagni - Pierantoni, Forlì, Italy.
Giorgio
G
Ercolani
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
Raffaele
R
Pezzilli
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
Matteo
M
Cescon
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
Giacomo
G
Frascaroli
Department of Medical and Surgical Sciences - DIMEC, S.Orsola - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.|S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
Antonio Daniele
AD
Pinna
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*