Abstract
Background
Most data on postoperative outcomes among patients with proximal extrahepatic cholangiocarcinoma
are reported by single institutions. The purpose of this study was to analyze postoperative
outcomes stratified by age and comorbidities.
Methods
Patients with proximal extrahepatic cholangiocarcinoma who underwent a resection were
identified in the National Cancer Database. Pathologic, postoperative, and survival
outcomes were compared based on age and Charlson-Deyo comorbidity index.
Results
Among the 1,579 patients, the average age was 66 years, and 9.4% of patients were
older than 80 years. Most patients had a Charlson-Deyo score of 0 (72.4%), with the
minority having scores of 1 (20.5%) or ≥2 (7.1%). Patients ≥80 years had a higher
90-day mortality rate compared with patients 65 to 79 and <65 years (21.3% vs 12.0%
vs 7.4%, P < .001). Patients with a Charlson-Deyo score ≥2 had longer duration of stay, greater
likelihood of requiring an unplanned readmission, and a higher 90-day mortality rate
compared with patients with a lower comorbidity index. Median survival of patients
<65, 65 to 79, and ≥80 years was 31, 24, and 17 months, respectively. A similar trend
was seen with increasing Charlson-Deyo score (0: 27 months, 1: 25 months, ≥2: 20 months).
On multivariable analysis, age ≥80 years (hazard ratio = 1.52, P = .01) and Charlson-Deyo score ≥2 (hazard ratio = 1.45, P = .01) were associated with poor survival.
Conclusion
In patients with proximal extrahepatic cholangiocarcinoma, age ≥80 years and greater
comorbidity index are associated with increased risk of 90-day mortality and poor
overall survival. This suggests that resections in high-risk patient populations should
be approached with caution.
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Article info
Publication history
Published online: October 18, 2020
Accepted:
September 10,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
