Division of Gastroenterological, Department of Surgery, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Surg Oncol. 2021 Jul;124(1):67-78. doi: 10.1002/jso.26488. Epub 2021 Apr 12.
In today's aging society, surgery is increasingly performed for older patients with perihilar cholangiocarcinoma (PHCC). This study aimed to examine survival and oncological outcomes in octogenarians with PHCC who underwent surgery.
We retrospectively examined 480 consecutive PHCC patients treated for PHCC between 1991 and 2020. Two hundred forty-seven underwent resection. Patient and clinical characteristics, including postoperative complications, overall survival (OS), and disease-free survival (DFS) were analyzed.
The proportion of octogenarians with PHCC undergoing surgery increased from 5.2% in 1991-2000 to 13.4% in 2016-2020. R0 resection and postoperative complication rates were comparable between octogenarians and younger patients. Five-year OS (30.0% vs. 31.7%) and DFS (20.0% vs. 29.5%) did not significantly differ. One-year OS was significantly better in octogenarians who underwent resection than those who did not (95.0% vs. 17.6%; p < .001). Two octogenarians who developed Clavien-Dindo grade III complications had undergone right hemihepatectomy (RH). Posthepatectomy liver failure and biliary leakage (Grade B) were also observed in octogenarians who underwent RH.
In well-selected octogenarians with PHCC, surgery offers short- and long-term outcomes comparable with those of their younger counterparts. RH may be considered in octogenarians on an individual basis.
在当今老龄化社会中，越来越多的高龄患者（80 岁以上）需要接受肝门部胆管癌（PHCC）手术。本研究旨在探讨 80 岁以上 PHCC 患者接受手术治疗的生存和肿瘤学结果。
我们回顾性分析了 1991 年至 2020 年间接受 PHCC 治疗的 480 例连续 PHCC 患者。其中 247 例行切除术。分析患者和临床特征，包括术后并发症、总生存期（OS）和无病生存期（DFS）。
80 岁以上 PHCC 患者接受手术的比例从 1991-2000 年的 5.2%增加到 2016-2020 年的 13.4%。80 岁以上患者和年轻患者的 R0 切除率和术后并发症发生率相当。5 年 OS（30.0% vs. 31.7%）和 DFS（20.0% vs. 29.5%）无显著差异。行切除术的 80 岁以上患者的 1 年 OS 显著优于未行切除术的患者（95.0% vs. 17.6%；p<0.001）。两名发生 Clavien-Dindo 分级 3 级并发症的 80 岁以上患者行右半肝切除术（RH）。行 RH 的 80 岁以上患者还出现了术后肝衰竭和胆漏（B 级）。
在精心选择的 80 岁以上 PHCC 患者中，手术可获得与年轻患者相当的短期和长期结果。可根据患者个体情况考虑行 RH。
