PDF(Pubmed)
Abstract：
The rapidly aging population in industrialized countries comes with an increased incidence of intrahepatic cholangiocarcinoma (iCC) which presents new challenges for oncological treatments especially in elderly patients. Thus, the question arises to what extent the benefit of surgical resections, as the only curative treatment option, outweighs possible perioperative risks in patients ≥ 80 years of age (octogenarians). We therefore retrospectively analyzed 311 patients who underwent resection for iCC at Hannover Medical School between January 1996 and December 2022. In total, there were 11 patients older than 80 years in our collective. Despite similar tumor size, octogenarians underwent comparatively less extensive surgery (54.5% major resections in octogenarians vs. 82.7% in all other patients; p = 0.033) with comparable rates of lymphadenectomy and tumor-free resection margins. Furthermore, we did not observe increased major postoperative morbidity (Clavien-Dindo ≥ IIIa complications: 27.3% vs. 34.3% in all other patients; p = 0.754) or mortality (estimated 1-year OS of 70.7% vs. 72.5% in all other patients, p = 0.099). The length of intensive care unit (ICU) or intermediate care unit (IMC) stay was significantly longer in octogenarians, however, with a comparable length in total hospital stay. The estimated overall survival (OS) did also not differ significantly, although a trend towards reduced long-term survival was observed (14.5 months vs. 28.03 months in all other patients; p = 0.099). In conclusion, primary resection is a justifiable and safe therapeutic option even in octogenarians but requires an even more thorough preoperative patient selection.
摘要：
工业化国家的快速老龄化人口伴随着肝内胆管癌（iCC）的发病率增加，这对肿瘤治疗尤其是老年患者提出了新的挑战。因此，问题是手术切除的好处在多大程度上，作为唯一的治愈性治疗选择，≥80岁(八十岁)患者的围手术期风险超过可能的风险.因此，我们回顾性分析了1996年1月至2022年12月在汉诺威医学院接受iCC切除术的311例患者。总的来说,我们共有11位80岁以上的患者.尽管肿瘤大小相似，八十岁的人接受了相对较少的广泛手术（八十岁的54.5％的大切除术与在所有其他患者中为82.7％；p=0.033），淋巴结清扫术和无瘤切缘的比率相当。此外，我们没有观察到术后主要发病率增加（Clavien-Dindo≥IIIa并发症：27.3%vs.在所有其他患者中为34.3％；p=0.754）或死亡率（估计1年OS为70.7％与所有其他患者的72.5%，p=0.099)。重症监护病房（ICU）或中间监护病房（IMC）的住院时间明显更长，然而,总住院时间相当长。估计的总生存期（OS）也没有显着差异，尽管观察到长期生存率降低的趋势(14.5个月vs.所有其他患者为28.03个月；p=0.099）。总之,即使在八十岁的老年人中,原发性切除术也是合理且安全的治疗选择,但需要更彻底的术前患者选择.
