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Published in: Journal of Hepato-Biliary-Pancreatic Sciences 3/2013

01-03-2013 | Original article

Surgical treatment of perihilar cholangiocarcinoma in octogenarians: a single center experience

Authors: Yu Takahashi, Tomoki Ebata, Yukihiro Yokoyama, Tsuyoshi Igami, Gen Sugawara, Masato Nagino

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 3/2013

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Abstract

Background/Purpose

Surgery can offer the only chance for a cure in patients with perihilar cholangiocarcinoma, and a growing number of elderly patients are undergoing resection. The purpose of this study was to evaluate the impact of patient age on surgery for perihilar cholangiocarcinoma.

Methods

From 2001 to 2011, 431 consecutive patients underwent a potentially curative resection for perihilar cholangiocarcinoma at the Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine. Perioperative and long-term outcomes after surgery were compared between octogenarians (80 years and older, n = 21) and younger patients (less than 80 years old, n = 410).

Results

All 21 octogenarians were healthy and deemed to be candidates for surgery; however, twenty (95 %) had one or more comorbidities. Nineteen (90 %) octogenarians underwent major hepatectomy with bile duct resection and the remaining two (10 %) underwent bile duct resection only, whereas almost all the (99 %) younger patients underwent hepatectomy (P = 0.021). Postoperative morbidity and mortality occurred in 57 and 5 % of the octogenarians, respectively. These rates were similar to those in the younger patients (P = 0.372 and P = 0.332, respectively). The overall 3- and 5-year survival rates in the octogenarians were both 56.8 %, and 3 patients survived for more than 5 years. Their survival rate was similar to that of the younger patients (P = 0.348).

Conclusions

Surgery for perihilar cholangiocarcinoma can be safely performed even in octogenarians, and careful patient selection can lead to acceptable morbidity, mortality, and long-term survival. Octogenarian patients should not be precluded from surgical resection for perihilar cholangiocarcinoma.
Literature
1.
go back to reference Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708 (discussion 10). Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708 (discussion 10).
2.
go back to reference Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406 (discussion 7). Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406 (discussion 7).
3.
go back to reference Ezaki T, Yukaya H, Ogawa Y. Evaluation of hepatic resection for hepatocellular carcinoma in the elderly. Br J Surg. 1987;74:471–3.PubMedCrossRef Ezaki T, Yukaya H, Ogawa Y. Evaluation of hepatic resection for hepatocellular carcinoma in the elderly. Br J Surg. 1987;74:471–3.PubMedCrossRef
4.
go back to reference Nagasue N, Chang YC, Takemoto Y, Taniura H, Kohno H, Nakamura T. Liver resection in the aged (seventy years or older) with hepatocellular carcinoma. Surgery. 1993;113:148–54.PubMed Nagasue N, Chang YC, Takemoto Y, Taniura H, Kohno H, Nakamura T. Liver resection in the aged (seventy years or older) with hepatocellular carcinoma. Surgery. 1993;113:148–54.PubMed
5.
go back to reference Fong Y, Blumgart LH, Fortner JG, Brennan MF. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg. 1995;222:426–34 (discussion 34–7). Fong Y, Blumgart LH, Fortner JG, Brennan MF. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg. 1995;222:426–34 (discussion 34–7).
6.
go back to reference Yeh CN, Jan YY, Chen MF. Hepatectomy for peripheral cholangiocarcinoma in elderly patients. Ann Surg Oncol. 2006;13:1553–9.PubMedCrossRef Yeh CN, Jan YY, Chen MF. Hepatectomy for peripheral cholangiocarcinoma in elderly patients. Ann Surg Oncol. 2006;13:1553–9.PubMedCrossRef
7.
go back to reference Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.PubMedCrossRef Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.PubMedCrossRef
8.
go back to reference Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassini D, De Santis M, et al. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis. 2007;22:77–83.PubMedCrossRef Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassini D, De Santis M, et al. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis. 2007;22:77–83.PubMedCrossRef
9.
go back to reference Figueras J, Ramos E, Lopez-Ben S, Torras J, Albiol M, Llado L, et al. Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? Clin Transl Oncol. 2007;9:392–400.PubMedCrossRef Figueras J, Ramos E, Lopez-Ben S, Torras J, Albiol M, Llado L, et al. Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? Clin Transl Oncol. 2007;9:392–400.PubMedCrossRef
10.
go back to reference Mann CD, Neal CP, Pattenden CJ, Metcalfe MS, Garcea G, Dennison AR, et al. Major resection of hepatic colorectal liver metastases in elderly patients—an aggressive approach is justified. Eur J Surg Oncol. 2008;34:428–32.PubMedCrossRef Mann CD, Neal CP, Pattenden CJ, Metcalfe MS, Garcea G, Dennison AR, et al. Major resection of hepatic colorectal liver metastases in elderly patients—an aggressive approach is justified. Eur J Surg Oncol. 2008;34:428–32.PubMedCrossRef
11.
go back to reference Kondo K, Chijiiwa K, Funagayama M, Kai M, Otani K, Ohuchida J. Hepatic resection is justified for elderly patients with hepatocellular carcinoma. World J Surg. 2008;32:2223–9.PubMedCrossRef Kondo K, Chijiiwa K, Funagayama M, Kai M, Otani K, Ohuchida J. Hepatic resection is justified for elderly patients with hepatocellular carcinoma. World J Surg. 2008;32:2223–9.PubMedCrossRef
12.
go back to reference Shirabe K, Kajiyama K, Harimoto N, Gion T, Tsujita E, Abe T, et al. Early outcome following hepatic resection in patients older than 80 years of age. World J Surg. 2009;33:1927–32.PubMedCrossRef Shirabe K, Kajiyama K, Harimoto N, Gion T, Tsujita E, Abe T, et al. Early outcome following hepatic resection in patients older than 80 years of age. World J Surg. 2009;33:1927–32.PubMedCrossRef
13.
go back to reference Oishi K, Itamoto T, Kobayashi T, Oshita A, Amano H, Ohdan H, et al. Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more. J Gastrointest Surg. 2009;13:695–701.PubMedCrossRef Oishi K, Itamoto T, Kobayashi T, Oshita A, Amano H, Ohdan H, et al. Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more. J Gastrointest Surg. 2009;13:695–701.PubMedCrossRef
14.
go back to reference Huang J, Li BK, Chen GH, Li JQ, Zhang YQ, Li GH, et al. Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy. J Gastrointest Surg. 2009;13:1627–35.PubMedCrossRef Huang J, Li BK, Chen GH, Li JQ, Zhang YQ, Li GH, et al. Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy. J Gastrointest Surg. 2009;13:1627–35.PubMedCrossRef
15.
go back to reference Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC. Safety of liver resection in the elderly: how important is age? Ann Surg Oncol. 2011;18:1088–95.PubMedCrossRef Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC. Safety of liver resection in the elderly: how important is age? Ann Surg Oncol. 2011;18:1088–95.PubMedCrossRef
16.
go back to reference Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, et al. Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery? J Surg Oncol. 2011;104:284–91.PubMedCrossRef Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, et al. Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery? J Surg Oncol. 2011;104:284–91.PubMedCrossRef
17.
go back to reference Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990;14:535–43 (discussion 44). Nimura Y, Hayakawa N, Kamiya J, Kondo S, Shionoya S. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990;14:535–43 (discussion 44).
18.
go back to reference Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.PubMedCrossRef Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.PubMedCrossRef
19.
go back to reference Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238:84–92.PubMed Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238:84–92.PubMed
20.
go back to reference Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.PubMed Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.PubMed
21.
go back to reference Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244:240–7.PubMedCrossRef Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244:240–7.PubMedCrossRef
22.
go back to reference Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–18 (discussion 19). Neuhaus P, Jonas S, Bechstein WO, Lohmann R, Radke C, Kling N et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–18 (discussion 19).
23.
go back to reference Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci. 2010;17:476–89.PubMedCrossRef Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci. 2010;17:476–89.PubMedCrossRef
24.
go back to reference Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.PubMedCrossRef Ebata T, Nagino M, Kamiya J, Uesaka K, Nagasaka T, Nimura Y. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 2003;238:720–7.PubMedCrossRef
25.
go back to reference Hemming AW, Kim RD, Mekeel KL, Fujita S, Reed AI, Foley DP et al. Portal vein resection for hilar cholangiocarcinoma. Am Surg. 2006;72:599–604 (discussion 5). Hemming AW, Kim RD, Mekeel KL, Fujita S, Reed AI, Foley DP et al. Portal vein resection for hilar cholangiocarcinoma. Am Surg. 2006;72:599–604 (discussion 5).
26.
go back to reference Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252:115–23.PubMedCrossRef Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg. 2010;252:115–23.PubMedCrossRef
27.
go back to reference Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.PubMedCrossRef Miyazaki M, Kato A, Ito H, Kimura F, Shimizu H, Ohtsuka M, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery. 2007;141:581–8.PubMedCrossRef
28.
go back to reference Sakamoto Y, Sano T, Shimada K, Kosuge T, Kimata Y, Sakuraba M, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg. 2006;391:203–8.PubMedCrossRef Sakamoto Y, Sano T, Shimada K, Kosuge T, Kimata Y, Sakuraba M, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg. 2006;391:203–8.PubMedCrossRef
29.
go back to reference Kaneoka Y, Yamaguchi A, Isogai M, Kumada T. Survival benefit of hepatopancreatoduodenectomy for cholangiocarcinoma in comparison to hepatectomy or pancreatoduodenectomy. World J Surg. 2010;34:2662–70.PubMedCrossRef Kaneoka Y, Yamaguchi A, Isogai M, Kumada T. Survival benefit of hepatopancreatoduodenectomy for cholangiocarcinoma in comparison to hepatectomy or pancreatoduodenectomy. World J Surg. 2010;34:2662–70.PubMedCrossRef
30.
go back to reference Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg (in press). Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y, et al. Hepatopancreatoduodenectomy for cholangiocarcinoma: a single-center review of 85 consecutive patients. Ann Surg (in press).
31.
go back to reference Sawada T, Kita J, Rokkaku K, Kato M, Shimoda M, Kubota K. Outcome of surgical resection for hilar cholangiocarcinoma in elderly patients. Hepatogastroenterology. 2008;55:1971–4.PubMed Sawada T, Kita J, Rokkaku K, Kato M, Shimoda M, Kubota K. Outcome of surgical resection for hilar cholangiocarcinoma in elderly patients. Hepatogastroenterology. 2008;55:1971–4.PubMed
32.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef
33.
go back to reference Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–62.PubMedCrossRef Nimura Y, Kamiya J, Kondo S, Nagino M, Uesaka K, Oda K, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–62.PubMedCrossRef
34.
go back to reference Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB (Oxford). 2005;7:259–62.CrossRef Nishio H, Nagino M, Nimura Y. Surgical management of hilar cholangiocarcinoma: the Nagoya experience. HPB (Oxford). 2005;7:259–62.CrossRef
35.
go back to reference Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–54.PubMedCrossRef Igami T, Nishio H, Ebata T, Yokoyama Y, Sugawara G, Nimura Y, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci. 2010;17:449–54.PubMedCrossRef
36.
go back to reference Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.PubMedCrossRef Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.PubMedCrossRef
37.
go back to reference Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246:1052–7.PubMedCrossRef Ikeyama T, Nagino M, Oda K, Ebata T, Nishio H, Nimura Y. Surgical approach to Bismuth type I and II hilar cholangiocarcinomas: audit of 54 consecutive cases. Ann Surg. 2007;246:1052–7.PubMedCrossRef
38.
go back to reference Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.PubMedCrossRef Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.PubMedCrossRef
39.
go back to reference Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–55.PubMedCrossRef Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–55.PubMedCrossRef
40.
go back to reference Kamiya S, Nagino M, Kanazawa H, Komatsu S, Mayumi T, Takagi K, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239:510–7.PubMedCrossRef Kamiya S, Nagino M, Kanazawa H, Komatsu S, Mayumi T, Takagi K, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239:510–7.PubMedCrossRef
41.
go back to reference Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390:104–13.PubMedCrossRef Kanazawa H, Nagino M, Kamiya S, Komatsu S, Mayumi T, Takagi K, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390:104–13.PubMedCrossRef
42.
go back to reference Sugawara G, Nagino M, Nishio H, Ebata T, Takagi K, Asahara T, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244:706–14.PubMedCrossRef Sugawara G, Nagino M, Nishio H, Ebata T, Takagi K, Asahara T, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244:706–14.PubMedCrossRef
43.
go back to reference Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer. 2011;14:139–43.PubMedCrossRef Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, et al. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer. 2011;14:139–43.PubMedCrossRef
44.
go back to reference Hellmann S, Schafmayer C, Hinz S, Schniewind B, Tepel J, Broering DC, et al. Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma. Hepatogastroenterology. 2010;57:403–8.PubMed Hellmann S, Schafmayer C, Hinz S, Schniewind B, Tepel J, Broering DC, et al. Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma. Hepatogastroenterology. 2010;57:403–8.PubMed
45.
go back to reference Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, et al. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15:189–97.PubMedCrossRef Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, et al. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15:189–97.PubMedCrossRef
46.
go back to reference Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, et al. Liver resection of colorectal metastases in elderly patients. Br J Surg. 2010;97:366–76.PubMedCrossRef Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, et al. Liver resection of colorectal metastases in elderly patients. Br J Surg. 2010;97:366–76.PubMedCrossRef
47.
go back to reference Reddy SK, Barbas AS, Turley RS, Gamblin TC, Geller DA, Marsh JW, et al. Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg. 2011;212:787–95.PubMedCrossRef Reddy SK, Barbas AS, Turley RS, Gamblin TC, Geller DA, Marsh JW, et al. Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg. 2011;212:787–95.PubMedCrossRef
Metadata
Title
Surgical treatment of perihilar cholangiocarcinoma in octogenarians: a single center experience
Authors
Yu Takahashi
Tomoki Ebata
Yukihiro Yokoyama
Tsuyoshi Igami
Gen Sugawara
Masato Nagino
Publication date
01-03-2013
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 3/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-012-0529-3

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