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Impact of Ageing on Hepatic Malignancy Resection: Is Age Really a Risk Factor for Mortality?

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Abstract

Background

With an ageing population, it is paramount for surgeons to comprehend the implications of age on surgical outcomes. This study aims to identify the effects of age on perioperative outcomes post-hepatectomy.

Methods

Between 2001 and 2017, 357 hepatectomies were performed in our centre for malignancy. Data recorded include demographic, histopathology and perioperative outcomes. Patients were divided into three age groups (Group 1 < 65 years, Group 2 65–74 years, Group 3 ≥ 75 years).

Results

With increasing age, there was a trend towards patient having: ASA ≥ 3 (from 32.1% to 60.9%, p < 0.0001), clear margins (from 80.4% to 88.3%, p = 0.2256), days of hospitalisation (from 9.5 ± 6.9 to 12 ± 8.0, p = 0.0003), days of ICU admission (from 2.3 ± 2.8 to 2.8 ± 12.9, p = 0.0790) and morbidity (from 39% to 58.5%, p = 0.0073). Cardiovascular complications and postoperative delirium increase with age. There was no significant difference in mortality across the three groups. Univariate and bivariate binary logistic regressions found no association between mortality and age. When adjusted for age, 30- and 90-day mortality was significantly associated with Clavien–Dindo ≥ 3, length of hospital and cardiac complications. Additionally, 90-day mortality was significantly associated with ASA score ≥3, mass of liver resected, length of ICU stay and hepatobiliary, pulmonary and genitourinary complications.

Conclusion

Increased age is associated with increased post-hepatectomy complications, prolonged hospital stay and ICU admission. However, age itself is not a contraindication for hepatectomy and is not associated with increased mortality. Good histopathology outcomes and low mortality rates are achievable with careful patient selection and appropriate perioperative management.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Faculty of Health and Medical Sciences, The University of Adelaide Medical School, Adelaide, South Australia, Australia

    Jianliang Liu

  2. Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia

    Jessica Reid, Markus Trochsler & Lisa Leopardi

  3. Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia

    Suzanne Edwards

  4. Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, 28 Woodville Road, Woodville, South Australia, 5011, Australia

    Guy Maddern

Authors
  1. Jianliang Liu
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  2. Jessica Reid
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  3. Markus Trochsler
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  4. Lisa Leopardi
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  5. Suzanne Edwards
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  6. Guy Maddern
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Corresponding author

Correspondence to Guy Maddern.

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The authors declare that they have no conflict of interest

Ethical approval

As this project was deemed to fall under audit and quality assurances, formal ethical review was not required. The Central Adelaide Local Health Network Human Research Ethics Committee acknowledged and approved the prospectively maintained database. All data have been managed appropriately under the Australian Code for the Responsible Conduct of Research.

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Liu, J., Reid, J., Trochsler, M. et al. Impact of Ageing on Hepatic Malignancy Resection: Is Age Really a Risk Factor for Mortality?. World J Surg 45, 841–848 (2021). https://doi.org/10.1007/s00268-020-05850-2

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  • DOI: https://doi.org/10.1007/s00268-020-05850-2

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