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

Abstract

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. 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). 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). 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.