Perioperative outcomes and long-term survival following resection of gallbladder cancer in older adults: retrospective study

Background: Gallbladder cancer (GBC) is a rare but aggressive disease, and surgical resection remains the only potential curative treatment. Although tumour-related effects on prognosis are well established, the impact of age is less understood. This study aimed to evaluate the influence of age on overall survival (OS), recurrence-free survival (RFS), and perioperative complications in GBC. Methods: Data from patients undergoing curative resection for GBC at 133 centres across 41 countries between 2010 and 2020 were analysed to determine the prognostic association of age ≥ 75 years with OS, RFS, and morbidity. Propensity score matching was used to address confounders between the two age groups. Results: In all, 4138 patients underwent surgery for GBC. Patients with macroscopic tumour remaining after surgery, metastatic disease, only high-grade dysplasia were excluded leaving 3676 patients for analyses. Full data on all relevant parameters was available for 2072 patients aged < 75 years and 633 patients aged ≥ 75 years. Patients aged ≥ 75 years had more co-morbidities, underwent less extensive surgery or lymphadenectomy, and received adjuvant chemotherapy less frequently than younger (< 75 years) patients. Age ≥ 75 years was associated with poorer OS in both the unmatched (hazard ratio (HR) 1.34; 95% confidence interval (c.i.) 1.14 to 1.56; P < 0.001) and matched cohorts (HR 1.31; 95% c.i. 1.12 to 1.54; P < 0.001) cohorts, but was not associated with RFS or 1-year survival. Tumour extent and nodal stage had the greatest association with OS and RFS. Age was not associated with increased complications in either the unmatched (odds ratio (OR) 1.11; 95% c.i. 0.85 to 1.45; P = 0.400) or matched (OR 0.90; 95% c.i. 0.72 to 1.12; P = 0.353) cohorts. Conclusions: Older adults received less extensive surgery and infrequent adjuvant chemotherapy. Age ≥ 75 years was associated with poorer OS following GBC resection but comparable complication rates to younger adults. Older adults of sufficient fitness should not be denied curative treatment based on age, and oncological benefit should be balanced against perioperative risk to personalize treatment and optimize surgical outcomes.