Pancreatoduodenectomy due to cancer in the older population

Abstract

By 2030, 70% of all pancreatic cancer will be diagnosed in the older population. However, pancreas operations are a complex surgical procedure with a high rate of morbidity and mortality. Therefore, the benefits of surgical resection in older patients are controversial and decisions about treatment for this group must be well balanced. Chronological age alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the comprehensive geriatric assessment (SGA), should be qualified for the same treatment as younger patients to benefit the same outcomes. However, they should be operated on in high-volume hospitals by experienced surgeons. Prefrail patients should undergo prehabilitation, during neoadjuvant treatment also, and then reevaluated. Frail patients should be discussed in an oncogeriatric meeting. We still do not have evidence-based data to design a tailored approach for them so as to balanced good oncologic outcomes and the appropriate postoperative quality of life.