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ID: 505 (Conflict of Interest: K)

Einfluss des Patientenalters auf das Ergebnis nach Major-Leberresektion bei perihilärem Cholangiokarzinom

M.Schmelzle, N.Raschzok, S.Moosburner, A.Andreou, B.Strücker, J.Plewe, R.Öllinger, M.Bahra, J.Pratschke
Charité - Universitätsmedizin Berlin, Berlin

Einleitung

Major hepatectomy for perihilar cholangiocarcinoma is still associated with a considerably high perioperative morbidity and mortality. The aim of this study was to analyze the perioperative outcome and overall survival after major hepatectomy for perihilar cholangiocarcinoma in elderly patients.

Material und Methoden

We retrospectively analyzed data of all consecutive patients undergoing major hepatectomy for perihilar cholangiocarcinoma between 2005 and 2015 at the Department of Surgery, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin. Perioperative outcome as well as 1-year and 3-year overall survival of patients ≥70 years (group 1) were compared to those of patients <70 years (group 2).

Ergebnisse

In the study period, 264 patients underwent major hepatectomy for perihilar cholangiocarcinoma, including 90 patients (34.1%) who were ≥70 years old (group1). No differences were evident between both groups with regard to the type of tumors according to Bismuth-Corlette, UICC-stage or rate of microscopically free margins. Of note, elderly patients were characterized by significantly less lymphatic vessel infiltration (group 1, 38.0%; group 2, 51.7%, p=0.04) and less organ metastases at time of resection (group 1, 1.8%; group 2, 10.3%, p=0.04). ICU stay, but not total length of hospital stay (p=0.2), was significantly longer in elderly patients (group 1, 12.5 days; group 2, 8.7; days, p<0.004), with a trend towards more major complications (Dindo-Clavien IIIb-V) (group 1, 42.2%; group 2, 30.9; p=0.5). There were no differences found between both groups with regard to tumor recurrence (group 1, 28.9%; group 2, 34.3%; p=0.2) as well as 1-year and 3-year overall-survival (group 1, 62.0% and 32.0%; group 2, 66.0% and 36.0%; both p=0.4).

Schlussfolgerung

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients (≥70 years) appears to be associated with perioperative outcome and survival rates comparable to those of patients <70 years. Extended surgical approaches to the liver should not be considered a contraindication for well-selected elderly patients.