Perioperative outcomes in an age-adapted analysis of the German StuDoQ|Pancreas registry for PDAC

Tengis Tschaidse; Felix O. Hofmann; Bernhard Renz; Maximilian Hungbauer; Carsten Klinger; Heinz J. Buhr; Waldemar Uhl; Sören Torge Mees; Tobias Keck; Christoph Reissfelder; Michael Ghadimi; Jan G. D’Haese; Jens Werner; Matthias Ilmer

doi:10.1186/s12893-024-02647-1

Perioperative outcomes in an age-adapted analysis of the German StuDoQ|Pancreas registry for PDAC

Tengis Tschaidse, Felix O. Hofmann, Bernhard Renz, Maximilian Hungbauer, Carsten Klinger, Heinz J. Buhr, Waldemar Uhl, Sören Torge Mees, Tobias Keck, Christoph Reissfelder, Michael Ghadimi, Jan G. D’Haese, Jens Werner, Matthias Ilmer^*

^*Corresponding author for this work

6 Citations (Scopus)

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) typically occurs in an older patient population. Yet, early-onset pancreatic cancer (EOPC) has one of the fastest growing incidence rates. This study investigated the influence of age and tumor location on postoperative morbidity and mortality in a large, real-world dataset. Methods: Patients with confirmed PDAC undergoing pancreatic surgery between 01/01/2014 and 31/12/2019 were identified from the German StuDoQ|Pancreas registry. After categorization into early- (EOPC; < 50 years), middle- (MOPC; 50 -70 years), and late-onset (LOPC; > 70 years), and stratification into pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), differences in morbidity and mortality as well as clinicopathologic parameters were analyzed. Results: In total, 3011 patients were identified. No difference in the occurrence of postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH) or delayed gastric emptying (DGE) between different age groups and resection techniques was detected. However, in patients undergoing PD, major complications (Clavien-Dindo ≥ 3a) were observed more frequently in LOPC (30,7%) than in MOPC (26,2%) and EOPC (16,9%; p < 0,01). Mortality almost tripled from EOPC (2,4%) to MOPC (3,6%) to LOPC (6,6%, p < 0,01) and significantly higher failure to rescue (FTR) rates could be observed (EOPC 14,3%, MOPC 13,6%; LOPC 21,6%; p < 0,05). In centers with DGAV certification for pancreatic surgery, the risk of complications was significantly decreased in PD (OR 0,79; 95% CI 0,65–0,94; p = 0,010). Conclusion: Age has a pronounced impact on the perioperative outcomes after pancreatic resections of PDAC. This effect is more prevalent in PD compared to DP. Pancreatic surgery-specific complications, such as POPF, DGE or PPH do not occur more frequently in the elderly. Overall, the risk of major complications and mortality increases in elderly patients mainly secondary to higher FTR rates.

Original language	English
Article number	4
Journal	BMC Surgery
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12893-024-02647-1
Publication status	Published - 12.2025

Funding

Funders	Funder number
German Cancer Research Center
Deutschen Konsortium für Translationale Krebsforschung

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Research Area: Luebeck Integrated Oncology Network (LION)

DFG Research Classification Scheme

2.22-14 Hematology, Oncology
2.22-25 General and Visceral Surgery

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10.1186/s12893-024-02647-1

Cite this

@article{62454205b76f4d24bcf0d0be8dda017a,

title = "Perioperative outcomes in an age-adapted analysis of the German StuDoQ|Pancreas registry for PDAC",

abstract = "Background: Pancreatic ductal adenocarcinoma (PDAC) typically occurs in an older patient population. Yet, early-onset pancreatic cancer (EOPC) has one of the fastest growing incidence rates. This study investigated the influence of age and tumor location on postoperative morbidity and mortality in a large, real-world dataset. Methods: Patients with confirmed PDAC undergoing pancreatic surgery between 01/01/2014 and 31/12/2019 were identified from the German StuDoQ|Pancreas registry. After categorization into early- (EOPC; < 50 years), middle- (MOPC; 50 -70 years), and late-onset (LOPC; > 70 years), and stratification into pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), differences in morbidity and mortality as well as clinicopathologic parameters were analyzed. Results: In total, 3011 patients were identified. No difference in the occurrence of postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH) or delayed gastric emptying (DGE) between different age groups and resection techniques was detected. However, in patients undergoing PD, major complications (Clavien-Dindo ≥ 3a) were observed more frequently in LOPC (30,7\%) than in MOPC (26,2\%) and EOPC (16,9\%; p < 0,01). Mortality almost tripled from EOPC (2,4\%) to MOPC (3,6\%) to LOPC (6,6\%, p < 0,01) and significantly higher failure to rescue (FTR) rates could be observed (EOPC 14,3\%, MOPC 13,6\%; LOPC 21,6\%; p < 0,05). In centers with DGAV certification for pancreatic surgery, the risk of complications was significantly decreased in PD (OR 0,79; 95\% CI 0,65–0,94; p = 0,010). Conclusion: Age has a pronounced impact on the perioperative outcomes after pancreatic resections of PDAC. This effect is more prevalent in PD compared to DP. Pancreatic surgery-specific complications, such as POPF, DGE or PPH do not occur more frequently in the elderly. Overall, the risk of major complications and mortality increases in elderly patients mainly secondary to higher FTR rates.",

author = "Tengis Tschaidse and Hofmann, \{Felix O.\} and Bernhard Renz and Maximilian Hungbauer and Carsten Klinger and Buhr, \{Heinz J.\} and Waldemar Uhl and Mees, \{S{\"o}ren Torge\} and Tobias Keck and Christoph Reissfelder and Michael Ghadimi and D{\textquoteright}Haese, \{Jan G.\} and Jens Werner and Matthias Ilmer",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

doi = "10.1186/s12893-024-02647-1",

language = "English",

volume = "25",

journal = "BMC Surgery",

issn = "1471-2482",

publisher = "BioMed Central Ltd",

number = "1",

}

TY - JOUR

T1 - Perioperative outcomes in an age-adapted analysis of the German StuDoQ|Pancreas registry for PDAC

AU - Tschaidse, Tengis

AU - Hofmann, Felix O.

AU - Renz, Bernhard

AU - Hungbauer, Maximilian

AU - Klinger, Carsten

AU - Buhr, Heinz J.

AU - Uhl, Waldemar

AU - Mees, Sören Torge

AU - Keck, Tobias

AU - Reissfelder, Christoph

AU - Ghadimi, Michael

AU - D’Haese, Jan G.

AU - Werner, Jens

AU - Ilmer, Matthias

PY - 2025/12

Y1 - 2025/12

N2 - Background: Pancreatic ductal adenocarcinoma (PDAC) typically occurs in an older patient population. Yet, early-onset pancreatic cancer (EOPC) has one of the fastest growing incidence rates. This study investigated the influence of age and tumor location on postoperative morbidity and mortality in a large, real-world dataset. Methods: Patients with confirmed PDAC undergoing pancreatic surgery between 01/01/2014 and 31/12/2019 were identified from the German StuDoQ|Pancreas registry. After categorization into early- (EOPC; < 50 years), middle- (MOPC; 50 -70 years), and late-onset (LOPC; > 70 years), and stratification into pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), differences in morbidity and mortality as well as clinicopathologic parameters were analyzed. Results: In total, 3011 patients were identified. No difference in the occurrence of postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH) or delayed gastric emptying (DGE) between different age groups and resection techniques was detected. However, in patients undergoing PD, major complications (Clavien-Dindo ≥ 3a) were observed more frequently in LOPC (30,7%) than in MOPC (26,2%) and EOPC (16,9%; p < 0,01). Mortality almost tripled from EOPC (2,4%) to MOPC (3,6%) to LOPC (6,6%, p < 0,01) and significantly higher failure to rescue (FTR) rates could be observed (EOPC 14,3%, MOPC 13,6%; LOPC 21,6%; p < 0,05). In centers with DGAV certification for pancreatic surgery, the risk of complications was significantly decreased in PD (OR 0,79; 95% CI 0,65–0,94; p = 0,010). Conclusion: Age has a pronounced impact on the perioperative outcomes after pancreatic resections of PDAC. This effect is more prevalent in PD compared to DP. Pancreatic surgery-specific complications, such as POPF, DGE or PPH do not occur more frequently in the elderly. Overall, the risk of major complications and mortality increases in elderly patients mainly secondary to higher FTR rates.

AB - Background: Pancreatic ductal adenocarcinoma (PDAC) typically occurs in an older patient population. Yet, early-onset pancreatic cancer (EOPC) has one of the fastest growing incidence rates. This study investigated the influence of age and tumor location on postoperative morbidity and mortality in a large, real-world dataset. Methods: Patients with confirmed PDAC undergoing pancreatic surgery between 01/01/2014 and 31/12/2019 were identified from the German StuDoQ|Pancreas registry. After categorization into early- (EOPC; < 50 years), middle- (MOPC; 50 -70 years), and late-onset (LOPC; > 70 years), and stratification into pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), differences in morbidity and mortality as well as clinicopathologic parameters were analyzed. Results: In total, 3011 patients were identified. No difference in the occurrence of postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH) or delayed gastric emptying (DGE) between different age groups and resection techniques was detected. However, in patients undergoing PD, major complications (Clavien-Dindo ≥ 3a) were observed more frequently in LOPC (30,7%) than in MOPC (26,2%) and EOPC (16,9%; p < 0,01). Mortality almost tripled from EOPC (2,4%) to MOPC (3,6%) to LOPC (6,6%, p < 0,01) and significantly higher failure to rescue (FTR) rates could be observed (EOPC 14,3%, MOPC 13,6%; LOPC 21,6%; p < 0,05). In centers with DGAV certification for pancreatic surgery, the risk of complications was significantly decreased in PD (OR 0,79; 95% CI 0,65–0,94; p = 0,010). Conclusion: Age has a pronounced impact on the perioperative outcomes after pancreatic resections of PDAC. This effect is more prevalent in PD compared to DP. Pancreatic surgery-specific complications, such as POPF, DGE or PPH do not occur more frequently in the elderly. Overall, the risk of major complications and mortality increases in elderly patients mainly secondary to higher FTR rates.

UR - https://www.scopus.com/pages/publications/85214079593

U2 - 10.1186/s12893-024-02647-1

DO - 10.1186/s12893-024-02647-1

M3 - Journal articles

C2 - 39755601

AN - SCOPUS:85214079593

SN - 1471-2482

VL - 25

JO - BMC Surgery

JF - BMC Surgery

IS - 1

M1 - 4

ER -

Perioperative outcomes in an age-adapted analysis of the German StuDoQ|Pancreas registry for PDAC

Abstract

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DFG Research Classification Scheme

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