Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality

Taylor S. Riall, Kristin M. Sheffield, Yong Fang Kuo, Courtney Townsend, James Goodwin

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31 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection. DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005). SETTING: Secondary data analysis of population-based tumor registry and linked claims data. PARTICIPANTS: Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship. MEASUREMENTS: Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group. RESULTS: Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001). CONCLUSION: With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.

Original languageEnglish (US)
Pages (from-to)647-654
Number of pages8
JournalJournal of the American Geriatrics Society
Volume59
Issue number4
DOIs
StatePublished - Apr 2011

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Pancreatic Neoplasms
Morbidity
Mortality
Medicare
Age Groups
Survival
Registries
Comorbidity
Epidemiology
Cohort Studies
Retrospective Studies
Databases
Population
Neoplasms

Keywords

  • age
  • pancreatic resection
  • short-term outcomes

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

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title = "Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality",
abstract = "OBJECTIVES: To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection. DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005). SETTING: Secondary data analysis of population-based tumor registry and linked claims data. PARTICIPANTS: Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship. MEASUREMENTS: Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group. RESULTS: Surgical resection rates increased significantly, from 20{\%} in 1992 to 29{\%} in 2005, whereas 30-day operative mortality rates decreased from 9{\%} to 5{\%}. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001). CONCLUSION: With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.",
keywords = "age, pancreatic resection, short-term outcomes",
author = "Riall, {Taylor S.} and Sheffield, {Kristin M.} and Kuo, {Yong Fang} and Courtney Townsend and James Goodwin",
year = "2011",
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doi = "10.1111/j.1532-5415.2011.03353.x",
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TY - JOUR

T1 - Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality

AU - Riall, Taylor S.

AU - Sheffield, Kristin M.

AU - Kuo, Yong Fang

AU - Townsend, Courtney

AU - Goodwin, James

PY - 2011/4

Y1 - 2011/4

N2 - OBJECTIVES: To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection. DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005). SETTING: Secondary data analysis of population-based tumor registry and linked claims data. PARTICIPANTS: Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship. MEASUREMENTS: Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group. RESULTS: Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001). CONCLUSION: With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.

AB - OBJECTIVES: To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection. DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005). SETTING: Secondary data analysis of population-based tumor registry and linked claims data. PARTICIPANTS: Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship. MEASUREMENTS: Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group. RESULTS: Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001). CONCLUSION: With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.

KW - age

KW - pancreatic resection

KW - short-term outcomes

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U2 - 10.1111/j.1532-5415.2011.03353.x

DO - 10.1111/j.1532-5415.2011.03353.x

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SP - 647

EP - 654

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

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