Surgical treatment of perihilar cholangiocarcinoma in octogenarians: a single center experience

Abstract

Background/purpose: Surgery can offer the only chance for a cure in patients with perihilar cholangiocarcinoma, and a growing number of elderly patients are undergoing resection. The purpose of this study was to evaluate the impact of patient age on surgery for perihilar cholangiocarcinoma.

Methods: From 2001 to 2011, 431 consecutive patients underwent a potentially curative resection for perihilar cholangiocarcinoma at the Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine. Perioperative and long-term outcomes after surgery were compared between octogenarians (80 years and older, n = 21) and younger patients (less than 80 years old, n = 410).

Results: All 21 octogenarians were healthy and deemed to be candidates for surgery; however, twenty (95 %) had one or more comorbidities. Nineteen (90 %) octogenarians underwent major hepatectomy with bile duct resection and the remaining two (10 %) underwent bile duct resection only, whereas almost all the (99 %) younger patients underwent hepatectomy (P = 0.021). Postoperative morbidity and mortality occurred in 57 and 5 % of the octogenarians, respectively. These rates were similar to those in the younger patients (P = 0.372 and P = 0.332, respectively). The overall 3- and 5-year survival rates in the octogenarians were both 56.8 %, and 3 patients survived for more than 5 years. Their survival rate was similar to that of the younger patients (P = 0.348).

Conclusions: Surgery for perihilar cholangiocarcinoma can be safely performed even in octogenarians, and careful patient selection can lead to acceptable morbidity, mortality, and long-term survival. Octogenarian patients should not be precluded from surgical resection for perihilar cholangiocarcinoma.