Abstract
Background
With the aging population, more elderly patients are being considered for hepatic resection. We investigated whether advanced age was associated with higher rate and severity of postoperative complications.
Methods
A total of 75 patients aged ≥70 years (group E) were matched with 75 patients aged <70 years (group Y) by the extent of liver resection and by operative indications. Primary outcome measures were rates and severity of complications. Secondary outcome measures were length of hospital stay and discharge destination. Univariate analysis was also performed to identify variables associated with higher surgical risk.
Results
Male-to-female ratio was 43:32 in both groups. Overall complication rates were 44 and 33.3% in group E and Y, respectively (P = 0.241; odds ratio = 1.57; 95% confidence interval [95% CI], 0.81–3.05). There was no mortality in both groups. The only postoperative age-related morbidity was confusion in the elderly. There was no difference in the rates of severe complications (grade ≥3) between group E and group Y (16 vs. 14.7%; P = 0.744; odds ratio = 1.11; 95% CI, 0.46–2.70). Median length of hospital stay were 7 and 6 days, respectively (P = 0.01). Nineteen percent and 1% of patients in group E and group Y were discharge to rehabilitation facilities, respectively (P = 0.001). Univariate analysis showed that preoperative systemic chemotherapy and longer operative time were associated with higher morbidity in the elderly.
Conclusions
Liver resection can be performed in patients aged ≥70 years as safely as in younger patients. Duration and timing of systemic chemotherapy before liver resection should be optimized to minimize postoperative morbidity.
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References
Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406.
Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708.
Menon KV, Al-Mukhtar A, Aldouri A, et al. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.
Fong Y, Brennan MF, Cohen AM, et al. Liver resection in the elderly. Br J Surg. 1997;84:1386–90.
de Liguori Carino N, van Leeuwen BL, Ghaneh P, et al. Liver resection for colorectal liver metastases in older patients. Crit Rev Oncol Hematol. 2008;67:273–8.
Dindo 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.
Petrowsky H, Clavien PA. Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients? World J Surg. 2005;29:1093–100.
Adam R, Frilling A, Elias D, et al. LiverMetSurvey Centres. Liver resection of colorectal metastases in elderly patients. Br J Surg. 2010;97:366–76.
Kondo K, Chijiiwa K, Funagayama M, et al. Hepatic resection is justified for elderly patients with hepatocellular carcinoma. World J Surg. 2008;32:2223–9.
Fortner JG, Lincer RM. Hepatic resection in the elderly. Ann Surg. 1990;211:141–5.
Hanazaki K, Kajikawa S, Shimozawa N, et al. Hepatic resection for hepatocellular carcinoma in the elderly. J Am Coll Surg. 2001;192:38–46.
Aldrighetti L, Arru M, Caterini R, et al. Impact of advanced age on the outcome of liver resection. World J Surg. 2003;27:1149–54.
Cescon M, Grazi GL, Del Gaudio M, et al. Outcome of right hepatectomies in patients older than 70 years. Arch Surg. 2003;138:547–52.
Ferrero A, Viganò L, Polastri R, et al. Hepatectomy as treatment of choice for hepatocellular carcinoma in elderly cirrhotic patients. World J Surg. 2005;29:1101–5.
Nagano Y, Nojiri K, Matsuo K, et al. The impact of advanced age on hepatic resection of colorectal liver metastases. J Am Coll Surg. 2005;201:511–6.
Mazzoni G, Tocchi A, Miccini M, et al. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis. 2007;22:77–83.
Ijtsma AJ, Boevé LM, van der Hilst CS, et al. The survival paradox of elderly patients after major liver resections. J Gastrointest Surg. 2008;12:2196–203.
Mann CD, Neal CP, Pattenden CJ, et al. Major resection of hepatic colorectal liver metastases in elderly patients—an aggressive approach is justified. Eur J Surg Oncol. 2008;34:428–32.
Huang J, Li BK, Chen GH, et al. Long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma undergoing hepatectomy. J Gastrointest Surg. 2009;13:1627–35.
Oishi K, Itamoto T, Kobayashi T, et al. Hepatectomy for hepatocellular carcinoma in elderly patients aged 75 years or more. J Gastrointest Surg. 2009;13:695–701.
Shirabe K, Kajiyama K, Harimoto N, et al. Early outcome following hepatic resection in patients older than 80 years of age. World J Surg. 2009;33:1927–32.
Cleary JM, Tanabe KT, Lauwers GY, Zhu AX. Hepatic toxicities associated with the use of preoperative systemic therapy in patients with metastatic colorectal adenocarcinoma to the liver. Oncologist. 2009;14:1095–105.
Vauthey JN, Pawlik TM, Ribero D, et al. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 2006;24:2065–72.
Belghiti J, Hiramatsu K, Benoist S, et al. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.
Kooby DA, Fong Y, Suriawinata A, et al. Impact of steatosis on perioperative outcome following hepatic resection. J Gastrointest Surg. 2003;7:1034–44.
Vetelainen R, van Vliet A, Gouma DJ, van Gulik TM. Steatosis as a risk factor in liver surgery. Ann Surg. 2007;245:20–30.
Nuzzo G, Giuliante F, Ardito F, et al. Liver resection for primarily unresectable colorectal metastases downsized by chemotherapy. J Gastrointest Surg. 2007;11:318–24.
Nordlinger B, Benoist S. Benefits and risks of neoadjuvant therapy for liver metastases. J Clin Oncol. 2006;24:4983–90.
Karoui M, Penna C, Amin-Hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg. 2006;243:1–7.
Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the Elderly ISPOCD1 Study. ISPOCD Investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet. 1998;351(9106):857–61.
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Cho, S.W., Steel, J., Tsung, A. et al. Safety of Liver Resection in the Elderly: How Important Is Age?. Ann Surg Oncol 18, 1088–1095 (2011). https://doi.org/10.1245/s10434-010-1404-6
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DOI: https://doi.org/10.1245/s10434-010-1404-6