Does an extreme age (≥80 years) affect outcomes in patients after liver cancer surgery? A meta‐analysis

Wei, Fangqiang

doi:10.1111/ans.14676

Cited by 7 publications

(5 citation statements)

References 53 publications

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“…This prolonged LOS appears beneficial in allowing postoperative monitoring and earlier management of complications. This observation contradicts previous studies that show no difference in morbidity rate between the young and elderly patients [8,9,15]. Possible explanations include the exclusion of complex resections and the limited types of complications being reported in some of these studies.…”

Section: Discussioncontrasting

confidence: 93%

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

et al. 2020

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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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Section: Discussioncontrasting

confidence: 93%

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

et al. 2020

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“…The outcome of HCC resection has improved through advances in diagnostic imaging studies, surgical techniques, and postoperative care [ 4 24 ]. We observed no differences in DFS or OS between the younger and older patients, as in previous studies [ 25 26 27 ]. Age was not an independent risk factor that determined a prognosis.…”

Section: Discussionsupporting

confidence: 87%

Hepatocellular carcinoma in old age: are there any benefits of liver resection in old age?

et al. 2020

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Purpose Elderly individuals have comorbidities that can adversely affect surgical outcomes. Some studies reported that elderly patients with hepatocellular carcinoma (HCC) have higher liver- and non-liver–related deaths. Therefore, palliative treatments are preferred in these patients. We compared surgical treatment outcomes between young and old age groups. Methods In total, 233 liver resections were performed in patients with HCC from March 2012 to December 2018. We retrospectively reviewed medical records. The old age group was defined as patients aged more than 70 years. We compared perioperative characteristics and surgical outcomes and analyzed the prognostic factors for disease-free survival (DFS) and overall survival (OS) rates. Results The young and old age group included 184 and 49 patients, respectively. Preoperative characteristics were similar. Major liver resection rate was similar (young age group, 26.1% vs. old age group, 20.4%), but the operation time was a little bit shorter in old age group. Major postoperative complications were 23 (12.5%) and 9 (18.4%) in the young and old age group (P = 0.351). Median non-liver–related overall survival were 80 and 76 months (P = 0.889) and liver-related OS were 76 and 76 months (P = 0.514) in the young and old age groups, respectively. Age was not an independent risk factor for DFS and OS. Conclusion Elderly patients showed similar non-liver- and liver-related OS rates as young patients after liver resection. Postoperative complications were also similar. If elderly patients are well selected, they can receive curative treatment and show good surgical outcomes.

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“…Elderly patients have increased sensitivity to anesthetics and are often comorbid with a variety of diseases, which seriously affects the reserve function of vital organs, making them less tolerant to anesthesia and surgery and increasing the risk of surgery, [39,40] as well as the possibility of some age-based medical decision making. [41][42][43] In addition, age is also associated with the incidence of CVD, with studies showing a higher rate of cardiovascular death with age. In addition, although surgery in patients in all age strata, Grade I/II, Tumorsize ≤ 2 cm, significantly reduces the risk of death directly from HCC, the risk of CVD is significantly higher, possibly due to the impact of the surgery itself on the patient's physical function and the fact that surgical treatment may require certain operations such as anesthesia and incisions, thus increasing the risk of CVD.…”

Section: Discussionmentioning

confidence: 99%

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

Cao,

Wang,

Yan

et al. 2023

Medicine

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Clinical data has shown that cardiovascular diseases (CVDs) have emerged as a prominent cause of mortality in individuals with hepatocellular carcinoma (HCC). This research aimed to reveal the comorbid effects of CVDs in patients with HCC. The cardiovascular mortality of patients diagnosed with HCC between 2000 and 2014 was compared to that of the general US population. Standardized mortality ratios were calculated to quantify the relative risk of cardiovascular mortality in HCC patients. The cumulative incidence of cardiovascular death (CVD) was estimated using Fine-Gray testing, and independent risk factors for CVD were determined using competing risk models. The results were analyzed using the Kaplan–Meier analysis. The overall SMR for CVD in HCC patients was 11.15 (95% CI: 10.99–11.32). The risk of CVD was significantly higher in patients aged < 55 years (SMR: 56.19 [95% CI: 54.97–57.44]) compared to those aged ≥ 75 years (SMR: 1.86 [95% CI: 1.75–1.97]). This study suggests that patients with HCC are at significant risk of developing CVD. Competing risk analyses indicated that age, grade, tumor size, surveillance, epidemiology, and end results stage, and surgical status were independent risk factors for CVD in patients with HCC. Therefore, patients with HCC require enhanced preventive screening and management of CVDs during and after treatment to improve patient survival.

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Does an extreme age (≥80 years) affect outcomes in patients after liver cancer surgery? A meta‐analysis

Abstract: Although an extreme age may not be a contraindication for undertaking liver cancer surgery, it may cause more morbidity. Perioperative intervention should be considered for prevention and early treatment of POI, delirium and cardiovascular events.

Cited by 7 publications

References 53 publications

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

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

Hepatocellular carcinoma in old age: are there any benefits of liver resection in old age?

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

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