Safety and indication of surgical treatment for elderly patients with gallbladder carcinoma

Abstract

Introduction: With average life expectancy rising globally, gallbladder carcinoma (GBC), a common malignancy with a poor prognosis is predicted to show higher incidence in elderly patients in the future. We analyzed surgical indications and their safety in elderly GBC patients aged ≥ 75 years and compared surgical outcomes between elderly and younger GBC patients. Methods: We retrospectively compared clinicopathological data and treatment outcomes in 22 patients aged ≥ 75 years (elderly group) and 22 patients aged < 75 years (younger group) among 44 consecutive GBC patients who underwent curative resection at Iwakuni Clinical Center between February 2008 and September 2017. Result: The proportion of preoperative comorbidities was significantly higher in the elderly than in the younger group (P = 0.02), as was the number of patients with pancreatobiliary malfunction. The American Society of Anesthesiologists score was higher in the elderly than in the younger group (P = 0.06), and they also showed a significantly shorter operation time. Postoperative delirium (P = 0.05) or postoperative hypoalbuminemia (P = 0.03) was more common in the elderly than the younger group. Liver function, body mass index, tumor staging, blood loss, and postoperative complications did not significantly differ between the groups. Both groups showed no operative mortality. Overall 3-year survival rates were comparable between the groups (younger 68% vs. elderly group 61%, log-rank test P = 0.55). Conclusion: Surgery can be safely performed in elderly GBC patients who can benefit as much as younger patients through careful patient selection.