Diminished benefit from resection of cancer of the head of the pancreas inpatients of advanced age

Background and Objectives: The incidence of pancreatic cancer is increasing , and an increasing proportion of these patients is older than 65 years. Th e benefits of resection in the geriatric population, in whom major comorbid ity is more likely, are poorly defined. The authors sought to determine the relative benefits of resection of cancer of the head of the pancreas in di fferent age groups, with particular emphasis on the geriatric population. Methods: Between 1983 and 1995, 273 patients presented to the University of Miami for evaluation of noncystic epithelial cancer of the head of the pan creas. Resection was performed in 104 patients, and these patients are the subject of this retrospective review. Mean length of followup for surviving patients was 37 +/- 24 months. Outcomes were compared in patients <65 year s old (group 1, n = 38), 65-74 years old (group 2, n = 47), and >74 years o ld (group 3, n = 19). Results: Total. pancreatectomy was performed in 12 patients and pancreatico duodenectomy was performed in 92 patients. The overall complication rate wa s similar in all groups, but major morbidity was highest in group 3 (P=0.05 ). Median survival for patients in group 2 was 25.1 months. Survival was si gnificantly shorter in patients from groups 1 and 3 (median survivals 12.4 months and 11.4 months, respectively; P = 0.02). Following control for Hisp anic ethnicity, which was also a significant prognostic factor on univariat e analysis, only the oldest age group had a. significantly shorter survival than the other two groups. Age >74 years and Hispanic ethnicity remained s ignificant after multivariate analysis. Conclusions: Long-term survival after resection is truncated in older patie nts. This finding and the observation that the major complication rate is h igher in the older subgroup emphasize the need to evaluate critically wheth er older patients should be submitted to radical resection. J. Surg. Oncol. 2001;77:115-122. (C) 2001 Wiley-Liss, Inc.