Evaluation of the validity of pancreatoduodenectomy in older patients with distal cholangiocarcinoma in terms of recurrence.

Abstract

Background: This retrospective study investigated the validity of pancreatoduodenectomy (PD) with regard to recurrence in older patients with distal cholangiocarcinoma (DC).

Methods: We compared 28 patients aged ≥ 75 years and 65 patients aged < 75 years who underwent PD for DC, and evaluated the relationship between age, clinicopathological factors, and outcomes.

Results: Postoperative mortality and morbidity rates did not differ between the groups. Although there were no significant differences in 5-year recurrence, disease-specific survival, and overall survival rates between the groups (45.4, 58.1, and 51.7% in patients ≥ 75 years and 50.3%, 62.7%, and 58.1% in patients < 75 years; P = 0.73, 0.44, and 0.24, respectively), the median time from recurrence to death (RTD) in older patients was significantly shorter than that in younger patients (0.5 years vs. 1.3 years, P = 0.013). In multivariate analysis, age ≥ 75 years (hazard ratio [HR]: 3.0), controlling nutritional status (CONUT) score ≥ 4 (HR: 2.5), poorly-differentiated adenocarcinoma or adenosquamous carcinoma (HR: 3.2), and failure to implement treatment after recurrence (HR: 5.3) were independent risk factors for a short time from RTD. Furthermore, at the time of recurrence, older patients had significantly poorer serum albumin levels, prognostic nutrition index, Glasgow prognostic score, and CONUT score. Age ≥ 75 years (odds ratio: 0.19) was an independent risk factor for implementation of treatment after recurrence.

Conclusions: PD in older patients may be acceptable; however, the median time from RTD was shorter owing to lower nutritional status and rates of treatment implementation after recurrence.