Surgical resection significantly impacts survival in patients 65 and older with localized pancreatic cancer.

• Five-year survival for surgical patients aged 65-74 is 25.6%, compared to just 2.0% for those without a surgery recommendation.
• Surgical treatment reduces cancer-specific mortality with an adjusted hazard ratio of 0.26 versus those who do not receive surgery.

Surgeons should prioritize surgical options for suitable older patients to enhance outcomes.

• Disparities in treatment uptake among sex and race underline the importance of tailored treatment decisions.