Value-Based Surgical Decision-Making in Octogenarians with Pancreatic Cancer: From Feasibility to Appropriateness

Background: Pancreatic resection in adults aged 80 years or older can be technically feasible, yet technical feasibility alone does not establish that surgery is appropriate for an individual patient. Decisions must balance potential oncological benefit against perioperative risk, functional recovery, competing mortality, and the outcomes that patients themselves value. Methods: This narrative review integrates evidence on pancreatic resection in octogenarians with principles from geriatric oncology, frailty assessment, rehabilitation, and shared decision-making. Particular attention is given to postoperative complications, recovery and discharge needs, non-operative alternatives, patient and caregiver priorities, and emerging perioperative indicators. Results: Selected octogenarians may achieve meaningful survival after resection, but observational studies are affected by selection bias and show increased risks of mortality and medical complications in many cohorts. Frailty, nutrition, cognition, baseline function, and social support help explain the marked heterogeneity between people of the same chronological age. A value-based framework integrating tumor biology, biological vulnerability, and patient-defined goals can make the decision process more transparent. Conclusions: The central question should move beyond whether resection is technically possible to whether its expected benefits are proportionate to its burdens and consistent with the patient’s goals. This framework supports individualized recommendations without either age-based exclusion or automatic escalation to surgery.