Abstract
Purpose
We evaluated the preoperative and postoperative characteristics and prognosis of super-elderly patients with hepatocellular carcinoma (HCC).
Methods
Four hundred and thirty-one patients who underwent hepatic resection for HCC were classified into three groups according to their age at the time of surgery: super-elderly (≥80 years; n = 20), elderly (70–80 years; n = 172) and younger (<70 years; n = 239). We compared the clinical characteristics, preoperative and postoperative factors and prognosis among the groups to evaluate whether liver resection is appropriate for super-elderly patients.
Results
The liver function was not significantly different among the groups. The proportion of patients with preoperative cardiovascular and respiratory disease and hypertension was higher in the super-elderly group compared to the other groups. The super-elderly group had shorter operations and reduced hemorrhage rates compared to the other groups. Postoperative cardiovascular complications and delirium were more frequently observed in the super-elderly group. The overall and tumor-free survival rates were not significantly different among the groups. Super-elderly patients had a lower rate of liver or HCC-related death and a higher rate of death due to other causes than the other groups.
Conclusions
Super-elderly HCC patients who are appropriately evaluated and selected might have a favorable prognosis after undergoing hepatic resection.
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References
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet. 2012;379:1245–55.
Ikai I, Arii S, Okazaki K. Report of the 17th Nationwide Follow-up Survey of Primary Liver Cancer in Japan. Hepatol Res. 2007;37:676–91.
Ministry of Health, Labour and Welfare. In: Japanese simple life table. 2010. http://www.mhlw.go.jp/toukei/saikin/hw/life/life06/index.html. Accessed 26 Jul 2011.
Ezaki T, Yukaya H, Ogawa Y. Evaluation of hepatic resection for hepatocellular carcinoma in the elderly. Br J Surg. 1987;74:471–3.
Yanaga K, Kanematsu T, Takenaka K, Matsumata T, Yoshida Y, Sugimachi K. Hepatic resection for hepatocellular carcinoma in elderly patients. Am J Surg. 1988;155:238–41.
Fortner JG, Lincer RM. Hepatic resection in the elderly. Ann Surg. 1990;211:141–5.
Yamada S, Shimada M, Miyake H, Utsunomiya T, Morine Y, Imura S, et al. Outcome of hepatectomy in super-elderly patients with hepatocellular carcinoma. Hepatol Res. 2012;42:454–8.
Tsujita E, Utsunomiya T, Yamashita Y, Ohta M, Tagawa T, Matsuyama A, et al. Outcome of hepatectomy in hepatocellular carcinoma patients aged 80 years and older. Hepatogastroenterology. 2012;59:1553–5.
Wu CC, Chen JT, Ho WL, Yeh DC, Tang JS, Liu TJ, et al. Liver resection for hepatocellular carcinoma in octogenarians. Surgery. 1999;125:332–8.
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.
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.
Kaibori M, Matsui K, Ishizaki M, Saito T, Kitade H, Matsui Y, et al. Hepatic resection for hepatocellular carcinoma in the elderly. J Surg Oncol. 2009;99:154–60.
Nagasue N, Chang YC, Takemoto Y, Taniura H, Kohno H, Nakamura T. Liver resection in the aged (70 years or older) with hepatocellular carcinoma. Surgery. 1993;113:148–54.
Takenaka K, Shimada M, Higashi H, Adachi E, Nishizaki T, Yanaga K, et al. Liver resection for hepatocellular carcinoma in the elderly. Arch Surg. 1994;129:846–50.
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.
Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, et al. Hepatic resection for hepatocellular carcinoma in the elderly. J Am Coll Surg. 2001;192:38–46.
Yeh CN, Lee WC, Jeng LB, Chen MF. Hepatic resection for hepatocellular carcinoma in elderly patients. Hepatogastroenterology. 2004;51:219–23.
Ferrero A, Vigano L, Polastri R, Ribero D, Lo Tesoriere R, Muratore A, et al. Hepatectomy as treatment of choice for hepatocellular carcinoma in elderly cirrhotic patients. World J Surg. 2005;29:1101–5.
Tsujita E, Utsunomiya T, Ohta M, Tagawa T, Matsuyama A, Okazaki J, et al. Outcome of repeat hepatectomy in patients with hepatocellular carcinoma aged 75 years and older. Surgery. 2010;147:696–703.
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 434–437).
Fong Y, Brennan MF, Cohen AM, Heffernan N, Freiman A, Blumgart LH. Liver resection in the elderly. Br J Surg. 1997;84:1386–90.
Caratozzolo E, Massani M, Recordare A, Bonariol L, Baldessin M, Bassi N. Liver resection in elderly: comparative study between younger and older than 70 years patients. Outcomes and implications for therapy. G Chir. 2007;28:419–24.
Poon RT, Fan ST, Lo CM, Liu CL, Ngan H, Ng IO, et al. Hepatocellular carcinoma in the elderly: results of surgical and nonsurgical management. Am J Gastroenterol. 1999;94:2460–6.
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.
Yamamoto K, Takenaka K, Matsumata T, Shimada M, Itasaka H, Shirabe K, et al. Right hepatic lobectomy in elderly patients with hepatocellular carcinoma. Hepatogastroenterology. 1997;44:514–8.
Schmucker DL. Age-related changes in liver structure and function: implications for disease? Exp Gerontol. 2005;40:650–9.
Aldrighetti L, Arru M, Catena M, Finazzi R, Ferla G. Liver resections in over 75-year-old patients; surgical hazard or current practice? J Surg Oncol. 2006;93:186–93.
Yoshimura Y, Kubo S, Shirata K, Hirohashi K, Tanaka H, Shuto T, et al. Risk factors for postoperative delirium after liver resection for hepatocellular carcinoma. World J Surg. 2004;28:982–6.
Terminology Committee of the IHPBA. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2:333–9.
Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, et al. Surgery for small liver cancers. Semin Surg Oncol. 1993;9(4):298–304.
Dingo 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.
Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–8.
Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24.
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A. Nozawa and other co-authors have no conflict of interest.
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Nozawa, A., Kubo, S., Takemura, S. et al. Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century. Surg Today 45, 851–857 (2015). https://doi.org/10.1007/s00595-014-0994-1
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DOI: https://doi.org/10.1007/s00595-014-0994-1