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

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.

Metabolic dysfunction-associated fatty liver disease increases the risk of complications after radical resection in patients with hepatocellular carcinoma

“…Additionally, we also revealed that aged ≥ 60 years, Child-Pugh grade B, tumor diameter ≥ 5 cm, and open hepatectomy were identified as risk factors for posthepatectomy complications, infectious and major complications in HCC and HBV-HCC patients, which is consistent with previous research findings [32][33][34][35][36]. This is because elderly patients may present with multiple comorbidities and experience gradual decline in organ function, resulting in compromised compensatory capacity of the liver and impaired regeneration ability of hepatocytes after radical resection [32]. Research has demonstrated that patients classified as Child-Pugh grade B (7 to 9 points) exhibit higher rates of postoperative complications and perioperative mortality compared to those Child-Pugh grade A (5 to 6 points) [33].…”

A new risk calculation model for complications of hepatectomy in adults over 75

“…Several studies have shown that age is a relevant factor for complications in liver surgery (Trundle et al 2019 ; Laporte and Kalil 2013 ). With increasing age, the complication rate of liver surgery has gradually increased (Liu et al 2021 ). A study of 663 patients who underwent hepatectomy showed that the 90-day mortality rates were 11.0%, 13.0%, and 17% for patients aged > 70, 75, and 80 years, respectively, and that the complication rates were 53%, 57%, and 66%, respectively (Shutt et al 2016 ).…”

Metabolic dysfunction-associated fatty liver disease increases the risk of complications after radical resection in patients with hepatocellular carcinoma

“…Additionally, we also revealed that aged ≥ 60 years, Child-Pugh grade B, tumor diameter ≥ 5 cm, and open hepatectomy were identi ed as risk factors for post-hepatectomy complications, infectious and major complications in HCC and HBV-HCC patients, which is consistent with previous research ndings. This is because elderly patients may present with multiple comorbidities and experience gradual decline in organ function, resulting in compromised compensatory capacity of the liver and impaired regeneration ability of hepatocytes after radical resection [33]. Research has demonstrated that patients classi ed as Child-Pugh grade B (7 to 9 points) exhibit higher rates of postoperative complications and perioperative mortality compared to those Child-Pugh grade A (5 to 6 points) [34].…”