Pancreatic surgery is safe in elder patients with PDAC

Abstract Background: In aging society, more and more elder people is diagnosed with pancreatic ductal adenocarcinoma (PDAC), unfortunately, these patients didn’t receive proper treatment compared to the non-elderly. Currently, there is controversy on whether surgery is safe in elderly pancreatic cancer patients. Methods: This single center, large scale retrospective study included PDAC patients receiving radical resection from 2012 to 2021 in Zhongshan Hospital, Fudan University. Patients were divided into non-elderly (<70) and elderly groups (≥70). We analyzed operation-related factors and postoperative complications between the two groups. And subgroup analysis was performed to evaluate the impact of inflammatory-nutritional status on the elderly and the non-elderly patients. Results: A total of 892 pancreatic cancer patients received radical resection was included, with 256 elderly and 636 non-elderly patients. Our study showed that the elderly pancreatic cancer patients had earlier eighth edition American Joint Committee on Cancer (8th AJCC) T stage (T3+T4, 10.59% vs 18.71%) and N stage (N0, 68.24% vs 55.22%), higher American Society of Anesthesiologists (ASA) grade (grade 2+ grade 3, 92.58% vs 87.70%), lower inflammatory markers (lymphocyte and lymphocyte to monocyte ratio) and poorer nutritional status (total protein, albumin, prealbumin, hemoglobin, transferrin, platelet). The incidence of post-operative complications (reoperation, postoperative pancreatic fistula, pulmonary embolism, surgery site infection and post-pancreatectomy hemorrhage) was comparable between the two groups, except for delayed gastric emptying (16.41% vs 22.83%, p=0.036). Moreover, poorer inflammatory-nutritional status was often associated with more complicated surgical procedure (longer surgical durations, higher intraoperative blood loss, and more resected lymph nodes), especially in non-elderly patients. Conclusion: With detailed preoperative evaluation and careful postoperative care, pancreatic surgery is safe for elderly patients in experienced pancreatic cancer center.