E273: Neoadjuvant Chemotherapy May Be Key to Improving Mortality and Survival for Octogenarians with Pancreatic Ductal Adenocarcinoma

ePoster Abstract Author(s)

Sarah B. Hays, MD (she/her/hers)

Resident Physician
Department of Surgery, NorthShore University HealthSystem
Evanston, Illinois, United States

Submitter(s)

Sarah B. Hays, MD (she/her/hers)

Resident Physician
Department of Surgery, NorthShore University HealthSystem
Evanston, Illinois, United States

Author(s)

Sarah B. Hays, MD (she/her/hers)

Resident Physician
Department of Surgery, NorthShore University HealthSystem
Evanston, Illinois, United States
KK

Kristine Kuchta, MS

Statistician
Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States
AR

Aram Rojas, MD

Research Scientist
Department of Surgery, NorthShore University HealthSystem, United States
Emile Farah, MD

Postdoctoral Researcher
Department of Surgery, University of Texas Southwestern Medical Center
Dallas, Texas, United States
Andres A. Abreu, MD (he/him/his)

Postsdoctoral Researcher
Department of Surgery, University of Texas Southwestern Medical Center
Dallas, Texas, United States
KR

Kristen Ranson, MS

Research Assistant
Department of Surgery, West Virginia University, United States
Asmita Chopra, MD (she/her/hers)

Research Resident
University of Pittsburgh Medical Center
Holland, Pennsylvania, United States
AK

Amudhan Kannan, MBBS

Postdoctoral Research Fellow
Department of Surgery, University of Texas Southwestern Medical Center, United States
IR

Imad Radi, MD

Resident Physician
Department of Surgery, University of Texas Southwestern Medical Center, United States
AP

Alessandro Paniccia, MD

Assistant Professor of Surgery
Department of Surgery, University of Pittsburgh Medical Center, United States
Brian A. Boone, MD, FACS

Assistant Professor
Department of Surgery, West Virginia University
Morgantown, West Virginia, United States
Patricio M. Polanco, MD

Associate Professor
Department of Surgery, University of Texas Southwestern Medical Center
Dallas, Texas, United States
Mark S. Talamonti, MD

Chair of Surgery
Department of Surgery, NorthShore University HealthSystem
EVANSTON, IL, United States
Amer H. Zureikat, MD

Professor and Chief
Division of Surgical Oncology, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Herbert J. Zeh, III, MD

Professor and Chair
Department of Surgery, University of Texas Southwestern Medical Center
Dallas, TX, United States
Melissa Hogg, MD MS (she/her/hers)

Chief of GI and General Surgery
Department of Surgery, NorthShore University HealthSystem
Evanston, Illinois, United States

Introduction:

As the population ages, so does the number of octogenarians presenting with pancreatic ductal adenocarcinoma (PDAC). Morbidity and mortality following pancreatectomy have improved; however, utilization and morbidity of multi-modality therapy has increased. This study compares the outcomes and multi-modality utilization in octogenarians who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for PDAC compared to a younger cohort.

Methods:

This is a multi-institutional retrospective review from 2007-2023 of patients who underwent PD or DP for PDAC. Pre-operative, peri-operative, and oncologic outcomes were analyzed, and multivariable analysis (MVA) was performed.

Results:

1438 patients underwent pancreatectomy for PDAC: 1196 PD (≥ 80: 149; < 80: 1047) and 212 DP (≥ 80: 30; < 80: 212). For PD, there was no difference in use of robotic approach, conversions, estimated blood loss (EBL), R0, or lymph node (LN) yield but octogenarians had shorter operative time (372 vs 403 minutes, p=0.0014), lower BMI (p=0.0021) and more prior abdominal surgery (p=0.0007). Octogenarians were more likely to have resectable disease (83.5% v 68.3%; p=0.0048) and be less likely to receive neoadjuvant chemotherapy (NAC) (26.2% v 51.6%; p< 0.0001), adjuvant (42.3% v. 68%; p < 0.0001), any chemotherapy (55.0% v 85.5%; p < 0.0001), or any radiation (8.1% v 25.4%; p< 0.0001) but there was no difference in AJCC stage. There was no difference in ISGPS B/C post-operative pancreatic fistula, bile leak, delayed gastric emptying, pseudoaneurysm (PSA), Clavien-Dindo (CD) score, or 90-day readmissions, however the octogenarian population had a greater length of stay (LOS) (9 vs 8 days, p=0.0061) and 90-day mortality (12.1% vs 3.8%, p < 0.0001). On MVA, octogenarians, increased EBL, and PSA were independent predictors of mortality; NAC protected against mortality. Using Kaplan-Meier estimates, overall survival from diagnosis was shorter in octogenarians (p=0.0047), without any difference in octogenarian survival with upfront surgery compared to NAC (p=0.2439). On MVA, lower BMI, higher CD score, LN ratio, LVI, PNI, and R1 decreased survival and NAC was only factor improving survival.

For DP, pre-operative demographics were similar to PD; however, no differences in peri-operative outcomes or survival were found.

Conclusions:

PD for PDAC in octogenarians does not increase morbidity but does increase 90-day mortality. Octogenarians underwent less NAC; however, NAC had a protective effect on mortality. Age did not impact DP outcomes or survival.

Learning Objectives:

Upon completion, participant will be able to explain the difference in post-operative outcomes amongst the octogenarian population with PDAC vs a younger cohort.
Following this presentation, participant should be able to discuss the benefits of neo-adjuvant therapy in the octogenarian population with PDAC.
Upon completion, participant will be able to identify the independent predictors of survival for patients with PDAC who underwent Whipple or distal pancreatectomy.