# Evaluation of the validity of pancreatoduodenectomy in older patients with distal cholangiocarcinoma in terms of recurrence

## TL;DR

This study evaluates whether pancreatoduodenectomy is valid for older patients with distal cholangiocarcinoma by comparing recurrence and survival outcomes with younger patients.

## Contribution

The study identifies age-related differences in post-recurrence survival and treatment implementation in distal cholangiocarcinoma patients undergoing pancreatoduodenectomy.

## Key findings

- Older patients had a significantly shorter median time from recurrence to death compared to younger patients.
- Age ≥75 years was an independent risk factor for shorter time from recurrence to death and lower treatment implementation after recurrence.
- Older patients had poorer nutritional status markers at recurrence compared to younger patients.

## Abstract

This retrospective study investigated the validity of pancreatoduodenectomy (PD) with regard to recurrence in older patients with distal cholangiocarcinoma (DC).

We compared 28 patients aged ≥ 75 years and 65 patients aged < 75 years who underwent PD for DC, and evaluated the relationship between age, clinicopathological factors, and outcomes.

Postoperative mortality and morbidity rates did not differ between the groups. Although there were no significant differences in 5-year recurrence, disease-specific survival, and overall survival rates between the groups (45.4, 58.1, and 51.7% in patients ≥ 75 years and 50.3%, 62.7%, and 58.1% in patients < 75 years; P = 0.73, 0.44, and 0.24, respectively), the median time from recurrence to death (RTD) in older patients was significantly shorter than that in younger patients (0.5 years vs. 1.3 years, P = 0.013). In multivariate analysis, age ≥ 75 years (hazard ratio [HR]: 3.0), controlling nutritional status (CONUT) score ≥ 4 (HR: 2.5), poorly-differentiated adenocarcinoma or adenosquamous carcinoma (HR: 3.2), and failure to implement treatment after recurrence (HR: 5.3) were independent risk factors for a short time from RTD. Furthermore, at the time of recurrence, older patients had significantly poorer serum albumin levels, prognostic nutrition index, Glasgow prognostic score, and CONUT score. Age ≥ 75 years (odds ratio: 0.19) was an independent risk factor for implementation of treatment after recurrence.

PD in older patients may be acceptable; however, the median time from RTD was shorter owing to lower nutritional status and rates of treatment implementation after recurrence.

The online version contains supplementary material available at 10.1007/s00423-025-03694-9.