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A multi‐institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma
Author(s) -
Vitale Alessandro,
Spolverato Gaya,
Bagante Fabio,
Gani Faiz,
Popescu Irinel,
Marques Hugo P.,
Aldrighetti Luca,
Gamblin T. Clark,
Maithel Shishir K.,
Sandroussi Charbel,
Bauer Todd W.,
Shen Feng,
Poultsides George A.,
Marsh J. Wallis,
Pawlik Timothy M.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24148
Subject(s) - medicine , perioperative , incidence (geometry) , propensity score matching , intrahepatic cholangiocarcinoma , gastroenterology , surgery , resection , physics , optics
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. Conclusion 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.