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Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications

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Abstract

Purpose

The prolonged life expectancy and increase in aging of the population have led surgeons to propose hepatectomy in the elderly population. In this study, we evaluate the surgical outcome of octogenarians in a single French center.

Methods

Between 2000 and 2020, 78 patients over 80 years old were retrospectively analyzed. The risk factors of major complications (Clavien-Dindo ≥ grade IIIa) and patient performance after surgery by using textbook outcome (TO) (no surgical complications, no prolonged hospital stay (≤ 15 days), no readmission ≤90 days after discharge, and no mortality ≤90 days after surgery) were studied.

Results

The main surgical indication was for malignancy (96%), including mainly colorectal liver metastases (n = 41; 53%) and hepatocellular carcinoma (n = 22; 28%), and major hepatectomy was performed in 28 patients (36%). There were 6 (8%) postoperative mortalities. The most frequent complications were pulmonary (n = 22; 32%), followed by renal insufficiency (n = 22; 28%) and delirium (n = 16; 21%). Major complications occurred in 19 (24%) patients. On multivariate analysis, the main risk factors for major complications were the median vascular clamping time (0 vs 35; P = 0.04) and male sex (P = 0.046). TO was ultimately achieved in 30 patients (38%), and there was no prognostic factor for achievement of TO.

Conclusions

Hepatectomy in octogenarians is associated with acceptable morbidity and mortality. Meanwhile, prolonged hepatic pedicle clamping should be avoided especially if hepatectomy is planned in a male patient.

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Data availability

The data that support the findings of this study are available from the corresponding author, Safi Dokmak, upon reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University of Paris, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, 92100, Clichy, France

    Kenji Yoshino, Yanis Hamzaoui, Tomoaki Yoh, Fadhel Samir Ftériche, Béatrice Aussilhou, Jacques Belghiti, Olivier Soubrane, François Cauchy & Safi Dokmak

  2. Department of Pathology, University of Paris, Hôpital Beaujon, AP-HP, Clichy, France

    Aurélie Beaufrère

Authors
  1. Kenji Yoshino
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  2. Yanis Hamzaoui
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  3. Tomoaki Yoh
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  4. Fadhel Samir Ftériche
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  5. Béatrice Aussilhou
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  6. Aurélie Beaufrère
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  7. Jacques Belghiti
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  8. Olivier Soubrane
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  9. François Cauchy
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  10. Safi Dokmak
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Contributions

S. Dokmak, K. Yoshino, and O. Soubrane conceived and designed the study. K. Yoshino, S. Dokmak, T. Yoh, F.S Ftériche, J. Belghiti, and O. Soubrane analyzed and interpreted the data. K. Yoshino, Y. Hamzaoui, B. Aussilhou, F. Cauchy, A. Beaufrère, S. Dokmak, and F.S Ftériche collected and assembled the data. K. Yoshino and S. Dokmak drafted the article.

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Correspondence to Safi Dokmak.

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Appendix

Appendix

Table 5 List of articles reporting surgical outcomes after liver resection in elderly (≥80 years) patients
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Yoshino, K., Hamzaoui, Y., Yoh, T. et al. Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications. Langenbecks Arch Surg 406, 1543–1552 (2021). https://doi.org/10.1007/s00423-021-02210-z

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