Liver resection in the elderly: A retrospective cohort study of 460 patients – Feasible and safe

Andert, Anne; Lodewick, Toine M.; Ulmer, Tom Florian; Schmeding, M.; Schöning, Wenzel; Neumann, Ulf; Dejong, Kees; Heidenhain, Christoph

doi:10.1016/j.ijsu.2016.02.060

Cited by 22 publications

(18 citation statements)

References 18 publications

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“…However, according to the literature, we have an increased rate of reoperation (9 vs. 5%) without postoperative mortality. Elderly patients did not have a higher rate of postoperative cardiopulmonary complications as also shown by Andert et al [17] in a retrospective cohort study of 460 elderly patients who underwent liver resection.…”

Section: Discussionsupporting

confidence: 58%

Major Hepatectomy for Colorectal Liver Metastases in Patients Aged Over 80: A Propensity Score Matching Analysis

et al. 2018

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Background: The aim of this study was to evaluate the results of major hepatectomies for metastasis in elderly colorectal cancer patients, for whom limited data exist in the literature. Methods: From January 2006 to January 2013, 3,034 patients underwent hepatectomy for colorectal liver metastasis in 32 French surgical centers. Repeat hepatectomies were excluded from the study. Based on a 1: 4 propensity score matching model, 42 patients aged ≥80 (OG) were matched with 168 patients <80 years (YG) in order to obtain 2 well-balanced and homogeneous groups with regards to therapy and prognostic factors. Results: The unmatched cohort consisted of 744 patients (OG: n = 42; YG: n = 702). After PS matching, there was no difference in terms of general morbidity, rates of Dindo-Clavien score ≥III (OG: 16% vs. YG: 21%, p = 0.663), surgical morbidity (OG: 16% vs. YG: 21%, p = 0.663), reoperation (OG:10% vs. YG: 5%, p = 0.263), 90-day mortality (OG: 0% vs. YG:2%, p = 1), and total median hospital stay (OG: 12 vs. YG: 12, p = 0.972). Both groups experienced similar 3- and 5-year overall survival (82 and 82% OG vs.78 and 67% YG) and disease-free survival (40 and 35% OG vs. 45 and 35% YG at 3 and 5 years). Conclusions: No difference in perioperative and postoperative outcomes and disease-free and overall survival was found. Major hepatectomy in selected octogenarian patients is safe and feasible.

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Section: Discussionsupporting

confidence: 58%

Major Hepatectomy for Colorectal Liver Metastases in Patients Aged Over 80: A Propensity Score Matching Analysis

et al. 2018

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“…Previous studies reported that liver resection via the open approach in the elderly (65 to 70 years) was very high mortality range from 3.5 to 5.6% [14, 15]. However, our results showed zero perioperative mortality rate of LH in elderly, which may associate with decreased blood loss and decreased surgical wall trauma with laparoscopic approach.…”

Section: Discussioncontrasting

confidence: 46%

The efficacy and safety of totally laparoscopic hepatectomy for non-cirrhotic hepatocellular carcinoma in the elderly

Yan

Chen

2018

BMC Surg

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BackgroundLaparoscopic hepatectomy (LH) has been identified to be effective and safe for elderly patients (≥70 years). This study aims to assess the short-and long-term outcome of totally laparoscopic liver resection for elderly patients with Hepatocellular carcinoma (HCC).MethodsWe retrospectively reviewed 93 patients with HCC who underwent LH from August, 2003 to July, 2013 in a single center. Short-term operative and postoperative outcomes together with long-term outcomes, including disease free survival (DFS) and overall survival (OS) were analyzed.ResultsA total of 81 patients was finally reviewed, of which 23 patients (28.40%) were grouped to elderly (≥70 years) and 58 patients (71.60%) were divided into younger group (< 70 years). The mean ages of patients in the elderly and younger cohorts were 74.9 ± 3.4 and 50.9 ± 12.7 years old, respectively. The median follow-up durations in elderly cohort and young cohort were 30 months and 24 months. The mean postoperative hospital stay was nearly 4 days longer in the elderly cohort than that in younger group (13.4 vs 9.5; p = 0.003). The elderly cohort has a higher rate of non-surgical complications than that in the younger cohort (P = 0.045), while the risks of surgical complications were comparable between the two groups. For the postoperative complications, elderly patients were more easily to develop grade III or more of Clavien-Dindo classification than that in the younger patients (P = 0.008). The median OS in the elderly group and younger group was 44.09 months and 42.49 months, respectively, with p = 0.089. The median DFS in the elderly group and the younger group was 39.87 months and 37.86 months, respectively, with p = 0.0616.ConclusionsElderly patients could obtain comparable operative and survival benefits from LH for HCC as younger counterparts. Age may not be a contraindication to laparoscopic liver resection for elderly patients.

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“…Some authors describe liver surgery in elderly patients as safe as in young [9, 19]. Others see slightly higher morbidity or mortality rates with especially postoperative pneumonia as a risk factor for mortality [20, 21]. Tufo and colleagues were able to show that the number of patients who underwent liver resection older than 70 years raised from 6% in 1990 to > 25% in 2007 [18].…”

Section: Discussionmentioning

confidence: 99%

Resection of intrahepatic cholangiocarcinoma in elderly patients – is it reasonable?

et al. 2019

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BackgroundIntrahepatic cholangiocarinoma (ICC) has a rising incidence in western countries. Often major or extended resections are necessary for complete tumor removal. Due to demographical trends the number of elderly patients diagnosed with ICC is rising accordingly. Aim of this study is to show whether resection of ICC in elderly patients is reasonable or not.MethodsBetween January 2008 and June 2018 all consecutive patients with ICC were collected. Analyses were focussed on the performed resection, its extent, postoperative morbidity and mortality as well as survival. Statistics were performed with Chi2 test for categorical data and for survival analyses the Kaplan Meier model with log rank test was used.ResultsIn total 210 patients underwent surgical exploration with 150 resections (71.4%). Patients were divided in 70-years cut-off groups (> 70 vs < 70 years of age) as well as a young (age 30–50, n = 23), middle-age (50–70, n = 76) and old (> 70, n = 51) group, whose results are presented here. Resectability (p = 0.709), extent of surgery (p = 0.765), morbidity (p = 0.420) and mortality (p = 0.965) was comparable between the different age groups. Neither visceral (p = 0.991) nor vascular (p = 0.614) extension differed significantly, likewise tumor recurrence (p = 0.300) or the localisation of recurrence (p = 0.722). In comparison of patients > or < 70 years of age, recurrence-free survival (RFS) was significantly better for the younger group (p = 0.047). For overall survival (OS) a benefit could be shown, but without reaching significance (p = 0.072). In subgroup analysis the middle-age group had significant better OS (p = 0.020) and RFS (p = 0.038) compared to the old group. Additionally, a better OS (p = 0.076) and RFS (p = 0.179) was shown in comparison with the young group as well, but without reaching significance. The young compared to the old group had analogous OS (p = 0.931) and RFS (p = 0.845).ConclusionResection of ICC in elderly patients is not associated with an increased perioperative risk. Even extended resections can be performed in elderly patients without obvious disadvantages. Middle-age patients have a clear benefit for OS and RFS, while young and old patients have a comparable and worse long-term outcome.

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Liver resection in the elderly: A retrospective cohort study of 460 patients – Feasible and safe

Cited by 22 publications

References 18 publications

Major Hepatectomy for Colorectal Liver Metastases in Patients Aged Over 80: A Propensity Score Matching Analysis

Major Hepatectomy for Colorectal Liver Metastases in Patients Aged Over 80: A Propensity Score Matching Analysis

The efficacy and safety of totally laparoscopic hepatectomy for non-cirrhotic hepatocellular carcinoma in the elderly

Resection of intrahepatic cholangiocarcinoma in elderly patients – is it reasonable?

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