Survival benefit of surgical resection in elderly patients with extrahepatic cholangiocarcinoma: a propensity score-matched analysis

PURPOSE: Extrahepatic cholangiocarcinoma (eCCA) predominantly affects elderly patients, yet robust evidence evaluating surgical effectiveness in this population remains limited. This study aimed to determine the independent survival benefit of surgical resection in elderly patients with eCCA using propensity score matching to minimize selection bias. METHOD: Patients aged ≥ 65 years with non-metastatic eCCA diagnosed between 2010 and 2017 were identified from the SEER database. One-to-one propensity score matching (caliper 0.05 SD) balanced baseline characteristics between surgical (n = 682) and non-surgical (n = 617) groups, yielding 184 matched pairs. Overall survival (OS) and cancer-specific survival (CSS) were compared using Kaplan-Meier analysis and multivariable Cox regression. RESULTS: In the matched cohort, surgical resection was associated with significantly improved survival for both endpoints. For OS: median survival was 29 vs 8 months (HR = 0.336, 95% CI: 0.267-0.423, P < 0.001), with 5-year OS rates of 25.3% vs 4.6%. For CSS: median survival was 36 vs 8 months (HR = 0.307, 95% CI: 0.237-0.396, P < 0.001), with 5-year CSS rates of 34.5% vs 7.4%. Surgical benefit remained consistent across all age strata (65-74y: HR = 0.32; 75-84y: HR = 0.29; ≥ 85y: HR = 0.34), with no age interaction (P = 0.89). Tumor stage modified treatment effect (P = 0.012), with greater benefit in T1-2 (HR = 0.27) than T3-4 disease (HR = 0.40), though both groups benefited significantly. CONCLUSION: Surgical resection was associated with substantial survival benefit in elderly patients with non-metastatic, resectable eCCA, with approximately 66% reduction in mortality risk persisting across all age groups including octogenarians. Chronological age alone should not preclude surgical evaluation; decisions should incorporate comprehensive geriatric assessment and tumor biology.