Bile duct carcinoma in the elderly. A rationale for surgical management
K. Saunders, R. Tompkins, W. Longmire Jr and J. Roslyn
Department of Surgery, UCLA School of Medicine 90024.
Recent studies have advocated the nonoperative treatment of elderly
patients with bile duct cancer using biliary endoprostheses. In addition to
a 30-day mortality rate of 9%, disadvantages with this approach include
lack of a definitive diagnosis and the inability to assess resectability.
For comparison, we reviewed 42 consecutive cases of bile duct cancer
managed surgically at UCLA (from 1954 to 1988) among patients age 70 years
or older. Histologic confirmation of bile duct cancer was obtained for 40
surgical patients (95%) in the series. The 30-day mortality rate was 10%.
There was a trend to more aggressive surgical management during the study,
with a concomitant doubling in survival rates (from 21% among patients
treated between 1954 and 1978 to 53% among patients treated between 1979
and 1988 at 1 year after surgery.) We conclude that elderly patients should
not be denied surgical evaluation of malignant neoplasms of the bile duct
simply on the basis of age.
