Some older patients with cholangiocarcinoma can benefit from surgery, a study by Japanese researchers found. According to the authors, assessing organ function is important when selecting candidates for surgery.

Cholangiocarcinoma is a group of rare malignant tumors originating from cells of the biliary tree. Surgery is usually the first treatment option but there are many contraindications, including metastatic disease. There is also limited evidence of the safety and benefits of surgery in older patients with extrahepatic cholangiocarcinoma.

The aims of the present study were to assess the potential benefits of surgery in older patients with extrahepatic cholangiocarcinoma and to shed light on differences in the general conditions of younger and older patients.

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The researchers analyzed 116 patients with extrahepatic cholangiocarcinoma who underwent curative surgery. They divided the patients into 2 groups according to age, those younger than 75 years of age and those 75 years and older.

They found that heart disease was significantly more common in older patients than in younger ones, but the heart function of the patients in the 2 groups was the same.

There were no significant differences in the prevalence of kidney and lung diseases between the groups. However, kidney function was significantly deteriorated in the older group. Moreover, the incidence of the mixed ventilatory defect was significantly higher in the older group. 

The 5-year overall survival rates were also comparable between the groups; 52.4% for younger patients and 50.4% for older patients. For patients with hilar cholangiocarcinoma, the 5-year survival rates were 42.4% in the younger group and 51.3% in the older group. Finally, for patients with distal cholangiocarcinoma, the 5-year survival rates were 69% for younger patients and 49.1% for older patients.

“Improved survival after surgery can be expected in well-selected older cholangiocarcinoma patients,” the researchers concluded. They added that “comorbidities were not necessarily reflected in organ function.”


Sumiyoshi T, Uemura K, Kondo N, et al. Is surgery justified for elderly patients with extrahepatic cholangiocarcinoma? Reappraisal from a viewpoint of comorbidity and organ function. Surg Today. Published online August 22, 2021. doi:10.1007/s00595-021-02340-3