Should age affect the decision to offer pancreaticoduodenectomy to patients with a suspected malignancy of the pancreatic head? Results from a multicentre study

Aim Prior studies have concluded that advanced age alone should not be an absolute contraindication to pancreaticoduodenectomy (PD). This study aimed to compare PD outcomes by patient age and quantify these risks. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients were grouped by their age and the following were compared: median length of stay (LoS), 30-day readmission rate, 90-day mortality rate, unplanned return to theatre rate, provision of nutritional support, five-year recurrence, and five-year survival. Comparisons were made using the Mann-Whitney U test and Fisher’s exact test. Results Concerning patient age, 7.1% were <50 years, 15.7% were 50-59, 36.7% were 60-69, 34.1% were 70-79 and 6.3% were ≥80. 90-day mortality rates were 3.8%, 3.0%, 1.7%, 5.7% and 7.4%, respectively, and five-year survival was 31.1%, 41.2%, 32.5%, 28.5% and 21.9%, respectively. When those aged <70 were compared to those ≥70, median LoS (13 vs 12.5 days, p = 0.8), 30-day readmission (9.6% vs 8.2%, p = 0.4), unplanned return to theatre rate (4.2% vs 6.0%, p = 0.15) and five year recurrence (62.4% vs 58.2%, p = 0.1) were similar but 90-day mortality (2.3% vs 5.8%, p = 0.0006) and five-year survival (34.6% vs 27.5%, p = 0.005) rates were significantly lower in the former. Conclusions Older patients should be considered for curative-intent PD if they have an appropriate performance status but one must consider the slightly higher rates of peri-operative mortality and reduced five-year survival.