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. 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.