Does radical resection improve the survival in patients with carcinoma of the gallbladder who are 75 years old and older?

ArticleinWorld Journal of Surgery 26(11):1315-8 · December 2002with6 Reads
DOI: 10.1007/s00268-002-6163-5 · Source: PubMed
Radical resections have been reported to improve the surgical outcome for patients with carcinoma of the gallbladder. In recent years surgeons have had more opportunities to operate on elderly patients. We investigated whether the survival rate of aged patients who had radical resections were better than rates for those who had simple cholecystectomy. Of the 300 patients treated for carcinoma of the gallbladder between 1971 and 1999, 206 resected cases (except pancreaticoduodenectomy and hepatectomy) were divided into two groups: age 75 years or older, 54 patients (the older group), and age less than 75 years, 152 patients (the younger group). Clinical features and progression of the carcinomas did not differ between the two groups. In the older group, 22 patients (40.7%) had simple cholecystectomy, 32 (59.3%) had radical resections; in the younger group, 65 patients (42.8%) had simple cholecystectomy, and 87 (57.3%) had radical resection. None of the older patients who had radical resection died postoperatively. Postoperative survival was not different between the two groups. In the older group the 5-year survival rate for patients who had radical resections was better (60.9%) than the rate for those who had simple cholecystectomy (14.1%) (p = 0.0098). Radical resection is effective for the aged patients with the carcinoma of gallbladder.
    • "A small number of observational cohort studies have addressed the issue of surgery in older patients with BTC, most of which failed to show age to be an independent risk factor influencing short-and long-term survival after surgery [18]. A retrospective study from Japan reported outcomes for 54 patients ≥75 years and 152 patients <75 years following resection of gallbladder cancer [19]. Approximately 58% of patients in both age groups underwent a radical resection and survival rates were similar between the two age groups. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Although biliary tract cancers (BTC) are common in older age-groups, treatment approaches and outcomes are understudied in this population. Patients and methods: Data from 913 patients diagnosed with BTC from January 1987 to July 2013 and treated at Princess Margaret Cancer Center, Toronto were analyzed. The differences in treatment patterns between older and younger patients were explored and the impact of age, patient and disease characteristics on survival outcomes was assessed. Results: Three hundred and twenty one patients ≥70 years were identified. Older patients were more likely to receive best supportive care, 40% (n = 130), compared to younger patients 26% (n = 154); p < 0.0001. On multivariable analysis, factors associated with receipt of surgery included stage I/II disease (p < 0.0001) and ECOG PS < 2 (p < 0.0001). Older age was not associated with lack of surgical intervention. In comparison, older age was associated with non-receipt of palliative chemotherapy (p = 0.0007). Similar survival benefit from treatment was seen in older and younger patients. Of 626 patients that underwent either surgery or palliative chemotherapy (n = 188), the median survival was 21.1 months (95% CI 19.0-27.9) in patients >70 years of age, and 21.1 months in younger patients (n = 438) (95% CI 19.5-24.5). Conclusion: In this large retrospective analysis, older patients with BTC are less likely to undergo an intervention. However, active therapy when given is associated with similar survival benefits, irrespective of age.
    Full-text · Article · Nov 2015
  • [Show abstract] [Hide abstract] ABSTRACT: More than two thirds of gastrointestinal cancers occur in persons 65 years of age or older. The symptoms and presentation in these older individuals appear similar to those of persons of younger age. Although treatments for these cancers have been developed primarily in younger patients, greater expertise over time has permitted similarly safe and efficacious therapy to be extended to older age groups. The majority of gastrointestinal cancers are located in the colon and rectum. Preventative strategies for colorectal cancer are quickly evolving, with the beneficial effect of long-term use of aspirin and estrogen having their greatest impact in the elderly population. The increased acceptance of colonoscopy for screening patients for colorectal cancer will be of greatest benefit in older individuals, who have a higher incidence of proximal neoplasms than younger individuals. Adjuvant therapy for both colon and rectal cancer is underutilized in elderly patients, despite such life-saving treatments resulting in similar survival prolongation, as well as toxicity profiles, as in their younger counterparts. There is a paucity of information concerning the treatment of elderly patients with other gastrointestinal malignancies.
    Article · May 2004
  • [Show abstract] [Hide abstract] ABSTRACT: Malignant hepato-pancreatico-biliary (HPB) tumors have their highest incidence within the sixth to eighth decades of life. The aging of the world population has resulted in a dramatic increase in the number of elderly patients considered for resection of malignant HPB tumors. Because elderly patients are more likely to have more co-morbidities, cognitive impairment, and decreased life expectancy, the benefit and appropriateness of these procedures must be scrutinized for geriatric patients. Therefore, many surgeons have compared the perioperative and long-term outcome of hepatic and pancreatic resections for elderly and younger patients. In most series the elderly population was defined by an age of 70 years or older. The results demonstrate that hepatic resection for hepatocellular carcinoma and colorectal liver metastases can be safely performed in well-selected elderly patients with long-term outcome comparable to younger patients. Similar findings are also reported for pancreatic resection in elderly patients with either ampullary or pancreatic cancer. Although the survival benefit of pancreatico-duodenectomy is limited in all age groups, the absence of competitive therapy justifies this procedure as the sole curative option in younger as well as older patients. Data on resection of gallbladder cancer and hilar bile duct cancer in the elderly are sparse, but there is evidence from large series on resection of these types of tumors that advanced age per se is not a risk factor for reduced outcome. Therefore, surgical options should not be denied to elderly patients with a malignant HPB tumor, and the evaluation should include surgeons expert in HPB surgery.
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