Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century

Nozawa, Akio; Kubo, Shoji; Takemura, Shigekazu; Sakata, Chikaharu; Urata, Yoshishige; Nishioka, Takayoshi; Kinoshita, Masahiko; Hamano, Genya; Uenishi, Takahiro; Suehiro, Shigefumi

doi:10.1007/s00595-014-0994-1

Cited by 59 publications

(71 citation statements)

References 30 publications

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“…Both studies did not show any survival difference between the two groups (<80 years and ≥80 years), but Nozawa et al15 reported more postoperative cardiovascular complications and delirium in the very elderly group, while no difference was seen in the Yamada’s study. Finally, Sulpice et al50 reviewed liver resections for HCC in 992 patients, including 152 aged ≥75 years.…”

Section: Surgical Treatmentmentioning

confidence: 87%

“…Two recent studies reported results of hepatectomy in a very elderly population, aged >80 years (n=20 and eleven patients) 15,49. Both studies did not show any survival difference between the two groups (<80 years and ≥80 years), but Nozawa et al15 reported more postoperative cardiovascular complications and delirium in the very elderly group, while no difference was seen in the Yamada’s study.…”

Section: Surgical Treatmentmentioning

confidence: 94%

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Hepatocellular carcinoma in elderly patients: challenges and solutions

Brunot

Sourd

Pracht

et al. 2016

JHC

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Hepatocellular carcinoma (HCC) is the second most common cause of death by cancer in the world. Due to the delayed HCC development in hepatitis C carriers and nonalcoholic fatty liver disease, the incidence of HCC in the elderly is increasing and is becoming a global health issue. Elderly patients with HCC should be assessed through proper oncologic approach, namely, screening tools for frailty (Geriatric-8 or Vulnerable Elders Survey-13) and comprehensive geriatric assessment. This review of the literature supports the same treatment options for elderly patients as for younger patients, in elderly patients selected as fit following proper oncogeriatric assessment. Unfit patients should be managed through a multidisciplinary team involving both oncological and geriatrician professionals. Specific studies and recommendations for HCC in the elderly should be encouraged.

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Section: Surgical Treatmentmentioning

confidence: 87%

Section: Surgical Treatmentmentioning

confidence: 94%

Hepatocellular carcinoma in elderly patients: challenges and solutions

Brunot

Sourd

Pracht

et al. 2016

JHC

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“…On the other hand, despite the fact that the risk of delirium, which is a major complication in elderly patients [26], should be considered before surgery, we were unable to evaluate its presence due to difficulties in defining delirium. The rate of postoperative delirium varied widely among previous papers (3–30%) [11, 12, 26], underscoring the importance of defining postoperative delirium to ensure its accurate evaluation [26]. …”

Section: Discussionmentioning

confidence: 99%

“…Those trends were consistent with the results of the present study. Moreover, 2 retrospective reports have recently shown the safety and feasibility of hepatectomy for patients with HCC ≥80 years of age [11, 12], with no significant differences in the overall or recurrence-free survival rates between patients < 80 and ≥80 years of age.…”

Section: Discussionmentioning

confidence: 99%

The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

et al. 2018

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Background: With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching. Methods: The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching – taking into consideration patient background, blood examination, and tumor factors – to minimize the effect of potential confounders. We then compared the results before and after the propensity matching. Results: Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups. Conclusion: Hepatectomy for HCC in elderly patients is justified.

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“…Наряду со снижением уровня послеоперационной леталь-ности и числа тяжелых хирургических осложнений, важней-шей задачей в этой группе пациентов является уменьшение количества неспецифических осложнений. Показано, что осложнения со стороны дыхательной и сердечно-сосу-дистой систем являются одной из значимых причин ле-тальности у пожилых пациентов [3], а развитие послео-перационной энцефалопатии затрудняет реабилитацию и значительно продлевает пребывание больных в стацио-наре [4]. Считается, что эффективным способом решения данной задачи является применение в периоперационном периоде так называемой концепции ускоренной послеопе-рационной реабилитации (ERAS -Enhanced Recovery After Surgery, или Fast-Track) в виде формализованных протоко-лов периоперационного ведения пациентов [5][6][7].…”

Section: Introductionunclassified

Prevention of Non-Surgical Complications After Hepatic Resections in the Elderly Patients

Лядов¹,

Козырин²

2016

Zlokač. opuholi

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РезюмеПациенты пожилого и старческого возраста составляют все более значимую группу среди оперированных на печени больных. Высокий риск развития осложнений со стороны сердечно-сосудистой и дыхательной систем, а также послеоперационной энцефалопатии делает актуальным поиск методов профилактики подобных неспецифических осложнений резекций печени в данной группе пациентов. Нами изучено влияние стандартизированного протокола периоперационного ведения пациентов с заболеваниями печени в возрасте до и старше 70 лет на частоту данных осложнений. Материалы и методыПроанализированы результаты лечения пациентов, которым была выполнена резекция печени в отделении хирургической онкологии ФГАУ «ЛРЦ» за 2013-2016 гг. Проведен сравнительный анализ результатов 122 плановых резекций печени, проведенных у 99 больных в возрасте до 70 лет, и 30 аналогичных вмешательств, выполненных у 29 более пожилых пациентов. Среди пациентов старше 70 лет была отмечена значительно более высокая частота сопутствующих заболеваний сердечно-сосудистой системы, в то время как у более молодх пациентов значительно чаще проводилась предоперационная химиотерапия. Результаты Различий между группами по объему операций, продолжительности кровопотери, длительности вмешательств отмечено не было. Число тяжелых (III-IV ст. по классификации Dindo-Clavien) осложнений у пациентов до и старше 70 лет, соответственно, составило 22% и 20%, летальных исходов -6% и 7%. Несмотря на сопоставимую долю обширных резекций в группах пациентов, у более пожилых пациентов чаще развивалась печеночная недостаточность (13 против 7%). Неспецифические осложнения развились у 3 пациентов: пневмония и сердечная недостаточность в группе больных до 70 лет, и фибрилляция предсердий в группе пожилых пациентов. Заключение Применение стандартизированного протокола периоперационного ведения пациентов, нуждающихся в резекции печени, позволяет снизить число неспецифических осложнений операции вне зависимости от возраста. AbstractElderly patients constitute a significant part of patients undergoing liver resection. Non-specific cardio-vascular and pulmonary complications as well as postoperative delirium are common in this group of patients. We analyzed the impact of a standardized perioperative care protocol on the rate of such complications after resections of the liver in patients younger and older than 70 years. Material and methodsWe analyzed the results of elective liver resections, performed in the Department of Surgical Oncology of the Medical and Rehabilitation Center under the Ministry of Health from 2013 to 2016. There were 122 resection in 99 patients less than 70 years old and 30 procedures in 29 elderly patients. Patients in the elderly group had significantly more cardio-vascular co-morbidities whereas younger patients have had preoperative chemotherapy more often. Results There were no differences regading the extent of liver resection, bloodloss, operating time. Severe morbidity (Clavien-Dindo III-IV grade) developed in 22 and 20% among patients younger and older 70, respectively, m...

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Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century

Abstract: Super-elderly HCC patients who are appropriately evaluated and selected might have a favorable prognosis after undergoing hepatic resection.

Cited by 59 publications

References 30 publications

Hepatocellular carcinoma in elderly patients: challenges and solutions

Hepatocellular carcinoma in elderly patients: challenges and solutions

The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

Prevention of Non-Surgical Complications After Hepatic Resections in the Elderly Patients

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