Efficacy and Safety of Surgical Treatment Among Older Adult Patients (80 Years) With Pancreatic Cancer: A Systematic Review and Meta‐Analysis

TL;DR

This study finds that surgery improves survival for older pancreatic cancer patients, though it carries higher risks compared to younger patients.

Contribution

This is the first meta-analysis evaluating surgical treatment for pancreatic cancer in patients aged 80 or older.

Findings

Surgical treatment had a higher two-year survival rate than chemotherapy in patients aged 80 or older with pancreatic cancer.

Older patients experienced similar morbidity but higher mortality and lower three-year survival rates compared to younger patients.

Surgical resection benefits older patients, but preoperative evaluation and shared decision-making are emphasized due to higher complication risks.

Abstract

With rapid population aging, the number of older adult patients presenting with pancreatic cancer is increasing. This meta‐analysis aimed to clarify the efficacy and safety of surgical interventions for pancreatic cancer among older adult patients.

Literature published in PubMed, Cochrane Library, and ICHUSHI databases until January 2024 was systematically searched. Comparative studies reporting outcomes of pancreatic cancer resection among patients aged 80 years or older were included in the analysis. Fifteen retrospective studies involving 22 647 patients were included in the meta‐analysis: 2930 patients aged 80 years or older who underwent pancreatic resection, 2059 patients aged 80 years or older treated with chemotherapy, and 17 658 patients under 80 years old.

Surgical treatment had a higher two‐year survival rate than chemotherapy among patients with pancreatic cancer aged 80 years or older. These patients experienced similar morbidity, higher mortality, and lower three‐year survival rates than those younger than 80 years.

Surgical treatment for pancreatic cancer improves survival rates even among patients aged 80 years or older; however, these patients may have a lower chance of recovering from complications. Patients should be informed of these objective findings to ensure shared decision‐making regarding the best treatment strategy.

This meta‐analysis by Ikenaga and colleagues is the first to evaluate surgical treatment for pancreatic cancer in patients aged 80 years or older. Surgical resection improved survival over chemotherapy, despite higher mortality and lower 3‐year survival than in younger patients. Findings highlight surgical benefit and the importance of preoperative evaluation and shared decision‐making.

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