Effect of surgery on the survival of elderly patients with early stage pancreatic cancer: A propensity-matched analysis

Background and objectives

Research about the effect of surgery in geriatric patients with early stage pancreatic ductal adenocarcinoma (PDAC) is limited, and it remains a subject of much debate. The purpose of this study was to evaluate the role of surgery on the survival of elderly patients with T1-3N0M0 PDAC and to further investigate the prognosis of these patients undergoing different surgical methods.

Methods

Patients aged ≥65 with T1-3N0M0 PDAC diagnosed in 2004–2016 were collected from the Surveillance, Epidemiology, and End Results database. The imbalance of baseline characteristics was reduced by propensity score matching. We used the log-rank tests to evaluate overall survival (OS) and cancer-specific survival (CSS) among different groups. Univariate and multivariate Cox regression analysis was utilized to explore prognostic factors in PDAC.

Results

In total, 6363 patients were enrolled. After matching, 1110 patients were paired. We found that surgery could provide better survival (p < 0.001). Moreover, compared with those who underwent partial resection or larger resection, patients who underwent local tumor destruction had poorer OS and CSS (p < 0.001). However, no statistically significant survival differences were shown between the partial resection group and the larger resection group (p < 0.001).

Conclusion

Surgical intervention could confer a survival benefit to elderly patients with early stage PDAC. Additionally, these patients could benefit from more radical operations, and radical operations with reasonable extents are advocated rather than too aggressive methods.