A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma.
BACKGROUND
Little is known regarding postoperative outcomes of elderly patients undergoing liver surgery for intrahepatic cholangiocarcinoma (ICC).


METHODS
Five hundred and eighty-four patients undergoing liver resection for ICC between 1990 and 2015 were identified. Perioperative morbidity, mortality, overall survival (OS), and disease-free survival (DFS) were compared between elderly (>70 year, n = 129) and non-elderly (≤70 years, n = 455) patients.


RESULTS
Older patients had a higher incidence of complications (elderly vs. non-elderly; 52.7% vs. 42.6%; P = 0.03), as well as major complications (elderly vs. non-elderly; 24.0% vs. 14.9%; P = 0.01); 30-day (0.1% vs. 3.3%; P > 0.05), and 90-day mortality (2.3% vs. 5.5%; P > 0.05) were comparable. Five-year OS and DFS were comparable between the elderly and non-elderly patients (OS, 13.3% vs. 24.4%; and DFS; 7.3% vs. 12.0%; P > 0.05). On propensity score matching, DFS and OS were also comparable among non-elderly versus elderly patients. Poor tumor grade was associated with worse DFS among elderly patients (HR = 1.6, 95%CI 1.0-2.6; P = 0.04), whereas periductal invasion (HR = 1.9, 95% CI 1.1-3.5; P = 0.03) and nodal disease (HR = 2.3, 95% CI 1.3-3.9; P = 0.003) were predictive of shorter DFS among non-elderly patients.


CONCLUSIONS
Elderly patients undergoing liver surgery for ICC demonstrated an increased risk of perioperative complications, but comparable long-term DFS and OS compared with younger patients. Rather, tumor characteristics were more predictive of worse long-term outcomes. J. Surg. Oncol. 2016;113:420-426. © 2016 Wiley Periodicals, Inc.
Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda Ospedaliera-Università di Padova, Padova, Italy.
Alessandro
A
Vitale
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gaya
G
Spolverato
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Fabio
F
Bagante
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Faiz
F
Gani
Fundeni Clinical Institute, Bucharest, Romania.
Irinel
I
Popescu
Curry Cabral Hospital, Lisbon, Portugal.
Hugo P
HP
Marques
Ospedale San Raffaele, Milan, Italy.
Luca
L
Aldrighetti
Medical College of Wisconsin, Milwaukee, Wisconsin.
T Clark
TC
Gamblin
Emory University, Atlanta, Georgia.
Shishir K
SK
Maithel
University of Sydney, Sydney, Australia.
Charbel
C
Sandroussi
University of Virginia, Charlottesville, Virginia.
Todd W
TW
Bauer
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Feng
F
Shen
Stanford University, Stanford, California.
George A
GA
Poultsides
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Wallis
JW
Marsh
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Timothy M
TM
Pawlik
D000367:Age Factors; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
elderly; hepatectomy; intrahepatic cholangiocarcinoma; liver resection; surgery