Octogenarians and Pancreatic Cancer: Is Surgery Always the Right Choice?

Background: Demographic change is leading to an increasing portion of octogenarians with pancreatic ductal adenocarcinoma (PDAC). Surgery remains a central component of curative-intent treatment. Nevertheless, it carries a risk of potentially life-threatening complications and high morbidity. Whether octogenarians benefit from surgery remains unclear. Methods: Using data from the clinical cancer registries of the 10th National Oncology Quality Conference of the ADT, we divided all patients with PDAC diagnosed between 2015 and 2023 into three age groups (≤65 years, n = 944; 66-79 years, n = 1535; ≥80 years, n = 537) and compared demographics, histopathology, treatment patterns, and survival data. Results: We observed an increasing proportion of octogenarians over the years from 15% in 2015 to 32% in 2023. While they were diagnosed with more favorable tumor stages, they more often received palliative chemotherapy (28% vs. 18%/19% in the younger cohorts). Only 24% of octogenarians who underwent surgery received adjuvant chemotherapy. Octogenarians had a worse overall and disease-free survival and 90-day mortality than the younger age groups. Furthermore, octogenarians with surgery or chemotherapy with curative intent alone had survival rates comparable to patients with palliative care. Conclusions: Octogenarians largely do not benefit from surgery alone. As only a quarter of octogenarians received adjuvant chemotherapy after surgery, neoadjuvant concepts might be useful for selecting patients who are fit enough to undergo and benefit from multimodal treatment.