Surgical management of locally advanced pancreatic cancer with arterial resections and reconstructions in elderly patients: Short- and long-term comparative outcomes.

Abstract

e16425 Background: Pancreatic cancer predominantly affects older adults, with peak incidence in the seventh and eighth decades of life. Locally advanced pancreatic cancer (LAPC) frequently presents with arterial involvement, historically limiting resectability. Advanced age further complicates treatment decisions, as concerns regarding operative risk, tolerance of complex vascular reconstruction, and perioperative morbidity have contributed to reluctance to pursue curative-intent resection in elderly patients. Consequently, older patients with arterial involvement are often excluded from surgical consideration despite potential oncologic benefit. We evaluated short- and long-term outcomes of pancreatectomy with arterial resection and reconstruction in elderly versus younger patients. Methods: We retrospectively analyzed 53 patients undergoing pancreatectomy for LAPC requiring arterial resection between December 2002 and September 2025 across two institutional series. Outcomes included margin status, length of stay (LOS), 90-day mortality, disease-free survival (DFS), overall survival (OS), OS from diagnosis, and Kaplan–Meier survival estimates stratified by age (≥70 vs < 70 years). Results: Among 53 patients, 20 were aged ≥70 years and 33 were < 70 years. Median age was 78 years (range 71–87) in elderly patients and 59 years (range 43–69) in younger patients. Median LOS was longer in elderly patients (12 days, range 4–53) compared with younger patients (8 days, range 5–24). Rates of margin-negative resection were comparable (R0: 85% in ≥70 vs 88% in < 70). Ninety-day mortality was higher in elderly patients (25.0% vs 6.1%). Median postoperative OS was 8.5 months (range 1–135) in elderly patients and 11 months (range 2–141) in younger patients; median DFS was 5 months (range 0–40) and 8 months (range 0–141), respectively. Median OS from diagnosis was 11 months (range 1–138) in the ≥70 cohort and 18 months (range 8–143) in the < 70 cohort. Two-year OS rates were similar (25.0% vs 27.3%), while 5-year OS was 5% in elderly patients and 12% in younger patients. Kaplan–Meier curves overlapped beyond the early postoperative period. Conclusions: In selected patients with LAPC, pancreatectomy with arterial resection and reconstruction can achieve meaningful long-term survival in elderly patients despite higher early postoperative risk. Advanced age alone should not preclude consideration of curative-intent resection within experienced multidisciplinary programs.