Clinical ScienceIs a surgical approach justified for octogenarians with pancreatic carcinoma? Projecting surgical decision making for octogenarian patients

- This journal feature begins with vignette highlighting clinical problems of a surgical approach justified for octogenarians with pancreatic carcinoma.
- Overall survival was similar between the groups (30 vs 26 months, P = .9).
- There were no significant differences in postoperative severe complication rates for younger and octogenarian groups (16% vs 20%, respectively, P = .5) or perioperative mortality rates (1.3% vs .0%, P = 1.0), but the incidence of postoperative delirium in the octogenarian group was greater than that in the younger group (23.5% vs 3.8%).
- Evidence supporting various strategies is then presented.
- The author ends with the author's clinical recommendations: octogenarian pancreatic cancer patients should not be denied a priori the opportunity for surgery, their only chance of cure, particularly if the patient represents an ideal candidate and if the co-operation of the family can be obtained.

BackgroundIn recent years, more elderly patients have undergone surgery for pancreatic cancer, although the safety and efficacy of performing complex pancreatic resections in patients older than 80 years remain controversial.MethodsPatients with pancreatic cancer who underwent curative surgical treatment were divided into 2 subgroups: the younger group (<80 years) and the octogenarian group (≥80 years).ResultsFrom March 2005 to December 2013, 194 consecutive surgically curable patients with diagnosed pancreatic cancer were studied, among which 34 (17.5%) were of 80 years or older. There were no significant differences in postoperative severe complication rates for younger and octogenarian groups (16% vs 20%, respectively) or perioperative mortality rates (1.3% vs .0%). The incidence of postoperative delirium in the octogenarian group was greater than that in the younger group (23.5% vs 3.8%).ConclusionsOctogenarian pancreatic cancer patients should not be denied a priori the opportunity for surgery, particularly if the patient represents an ideal candidate and if the co-operation of the family can be obtained.