Age no limit for perihilar cholangiocarcinoma resection

Last Updated: 2018-08-21

By Reuters Staff

NEW YORK (Reuters Health) - Advanced age alone should not be a contraindication to surgery for perihilar cholangiocarcinoma (PHCC), researchers from Japan report.

Operative treatment is rarely offered to elderly patients with PHCC due to the difficulty, risks and complexity of resection, but whether surgery is beneficial in these patients remains unclear.

Dr. Masato Nagino and colleagues from Nagoya University Graduate School of Medicine review their experiences with resection for PHCC in a report online August 3 in Surgery.

From 1977 through 2015, 831 consecutive patients underwent resection for PHCC. Patients under age 60 accounted for 53% of these patients before 1991 but only 16% after 2010.

Patients in their 60s accounted for about a third of resections, with little change during this interval.

Only 13% of patients before 1991 were aged 70 to 79 years, while after 2010 this age group represented 41% of those resected. No octogenarians underwent resection before 2001, but after 2010 octogenarians accounted for nearly 10% of those resected.

As a result of these trends, the median patient age increased gradually from 59 years in 1979-1990 to 65 years in 1991-2005, 68 years in 2006-2010 and 70 years thereafter.

The resectability rate was approximately 70% between 2001 and 2015, without significant differences among the age groups.

Octogenarians were more likely to undergo bile duct resection without hepatectomy and less likely to undergo extended hepatectomies, compared with other age groups.

Apart from higher rates of postoperative pneumonia for octogenarians (8% vs. 1% for younger patients), the incidence of postoperative complications did not differ significantly by age group.

Perioperative mortality was 2.0% and did not differ significantly between the age groups.

Overall survival five years after surgery did not differ significantly between octogenarians (41%) and other patients (39%), but disease-specific survival was nonsignificantly better for octogenarians than for other patients (50% vs. 40.2% at five years).

Survival among unresected patients was also similar regardless of age, but it was considerably lower than that for patients who underwent resection (for example, 6% for unresected octogenarians and 1% for other unresected patients at three years).

"Operative therapy with resection of PHCC under careful patient selection can be performed with low mortality irrespective of age and offers a better chance of long-term survival even in octogenarians," the researchers conclude. "In the current aging society, surgeons are increasingly treating more elderly patients with cancer. Elderly patients with PHCC should not be precluded from appropriate resection of PHCC solely due to age."

Dr. Nagino did not respond to a request for comments.

SOURCE: https://bit.ly/2OQIEUg

Surgery 2018.