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Life sciences · Journal article
Research and Practical Medicine Journal · September 20, 2026
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Pancreatic cancer is typically diagnosed at an advanced stage and predominantly affects older adults. Given population aging and improvements in the overall health status of older individuals, the appropriateness, safety, and patient selection criteria for pancreaticoduodenectomy in patients aged ≥ 75 years are becoming increasingly important clinical considerations. Purpose of the study. To systematize current evidence on the short- and long-term outcomes of pancreaticoduodenectomy in patients aged ≥ 75 years, identify key risk factors for adverse outcomes, formulate criteria for selecting candidates for surgical treatment, and assess the effectiveness of alternative therapeutic approaches in this patient population. Materials and methods. A systematic search and analysis of current Russian and international publications, including original studies, systematic reviews, meta-analyses, and clinical guidelines, were performed. The literature search covered the PubMed/MEDLINE, Scopus, Web of Science, and eLIBRARY.RU databases for the period from 2010 to 2025. Postoperative mortality, complication rates, long-term survival, quality of life, and factors influencing clinical decisionmaking were critically evaluated. Results. Chronological age alone was not found to be an independent predictor of adverse outcomes after pancreaticoduodenectomy. The principal risk determinants were biological age, assessed using the ASA physical status classification and ECOG performance status, frailty, and nutritional deficiency. Perioperative chemotherapy was identified as a major independent prognostic factor capable of mitigating the adverse impact of age. Comprehensive geriatric assessment, ERAS protocols, prehabilitation, and minimally invasive surgical approaches may improve treatment outcomes. Effective alternatives for high-risk patients include systemic chemotherapy, stereotactic body radiotherapy, radiofrequency ablation, electroporation of pancreatic tumors, photodynamic therapy for distal common bile duct tumors, and endoscopic resection of major duodenal papilla neoplasms. Conclusion. The appropriateness of pancreaticoduodenectomy in patients aged ≥75 years should be determined not by chronological age but by an integrated assessment of the patient’s functional reserve, or biological age, tumor biology, and eligibility for multimodal treatment, including chemotherapy. Clinical decision-making requires a mandatory multidisciplinary approach involving a geriatrician and should be based on contemporary risk-stratification algorithms and the principles of personalized medicine.