Introduction:
Despite advances in multidisciplinary treatment, pancreatic cancer remains highly refractory. The role and benefit of performing pancreaticoduodenectomy (PD)—a highly invasive procedure—in elderly patients over 80 years of age remains unclear.
Purpose:
This study aimed to evaluate the safety and efficacy of PD in patients aged 80 and above and to examine whether advanced age should be a contraindication to surgical intervention.
Patients and Methods:
We retrospectively analyzed 53 patients who underwent PD for pancreatic cancer between January 2006 and May 2024 at our institution. Patients were divided into two groups: those≥80 years old (n = 13) and those <80 years old (n = 40). Clinicopathological factors, perioperative outcomes, recurrence-free survival (RFS), and overall survival (OS) were compared.
Results:
The median age was 74 (range: 46–91), with 31 males and 22 females. Pathological staging (pStage I/II) was similar between the two groups. While the elderly group had more preoperative comorbidities, such as cerebral infarction and respiratory disease, there were no significant differences in performance status or nutritional indices. Intraoperative parameters, including blood loss, operative time, and R0 resection rates, were comparable.
Postoperative complication rates, including pancreatic fistula, delayed gastric emptying, and Clavien–Dindo grade ≥3A events, showed no significant differences. However, the completion rate of adjuvant chemotherapy was significantly lower in the ≥80 group (38% vs. 79%, p=0.012), and only one patient (14%) received chemotherapy after recurrence.
The 1-year RFS was 47% (≥80) vs. 55% (<80), while the 1-year OS was significantly lower in the ≥80 group: 39% vs. 80% (p=0.002). Cancer-specific survival mirrored this trend.
Conclusion:
PD can be performed safely in well-selected patients over 80 with acceptable perioperative outcomes. However, limited tolerance for adjuvant or recurrence chemotherapy may undermine long-term survival benefits. Careful patient selection and realistic expectation-setting are crucial when considering PD in this age group.