Management and Perioperative Morbidity Among Patients With Surgically Managed Pancreatic Adenocarcinoma: A Population-Based Analysis Using SEER-Medicare Data

Introduction: Older patients with pancreatic cancer are often not offered pancreaticoduodenectomy (PD) due to potentially high perioperative risk and prolonged post-operative recovery. These patients may have undetected vulnerabilitities related to frailty that may adversely affect surgical outcomes. Methods: PD-eligible patient over 50 were enrolled onto this IRB-approved prospective observational study. Extensive perioperative clinical information including Vulnerable Elder Survey (VES-13), short physical performance battery (SPPB), and Fried's Criteria for frailty were collected. Complications were prospectively recorded and graded according to established guidelines (Clavien scores). Quality of life (QoL) measures were taken at baseline and at 1, 3, and 6-months post-PD. Results: Seventyeight patients were enrolled from 10/1/2007-9/1/2010: 53 had a PD (median age 68 years;range 46-85) and 25 were inoperable or declined PD. Significant preoperative vulnerability was identified in resected patients; VES-13 >3 in 24%; SPPB