A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma

Alessandro Vitale, Gaya Spolverato, Fabio Bagante, Faiz Gani, Irinel Popescu, Hugo P. Marques, Luca Aldrighetti, T. Clark Gamblin, Shishir K. Maithel, Charbel Sandroussi, Todd W. Bauer, Feng Shen, George A. Poultsides, J. Wallis Marsh, Timothy M. Pawlik

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Abstract

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.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
DOIs
Publication statusAccepted/In press - 2016

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Keywords

  • Elderly
  • Hepatectomy
  • Intrahepatic cholangiocarcinoma
  • Liver resection
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Vitale, A., Spolverato, G., Bagante, F., Gani, F., Popescu, I., Marques, H. P., ... Pawlik, T. M. (Accepted/In press). A multi-institutional analysis of elderly patients undergoing a liver resection for intrahepatic cholangiocarcinoma. Journal of Surgical Oncology. https://doi.org/10.1002/jso.24148