Prognosis of patients with hepatocellular carcinoma after hepatic resection: Are elderly patients suitable for surgery?

Nanashima, Atsushi; Abo, Takafumi; Nonaka, Takashi; Fukuoka, Hidetoshi; Hidaka, Shigekazu; Takeshita, Hiroaki; Ichikawa, Tatsuki; Sawai, Terumitsu; Yasutake, Toru; Nakao, Kazuwa; Nagayasu, Takeshi

doi:10.1002/jso.21932

Cited by 83 publications

(98 citation statements)

References 45 publications

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“…Nanashima et al [38] showed that incidence of PHLF is not affected by age even though systemic complications are increased in elderly patients (≥70 years; 15 vs. 3%; p < 0.05). According to some authors, advanced age (≥70 years) increased the risk of postoperative morbidity and mortality with odds ratios of 1.02 (95% CI 1.01–1.03; p < 0.01) and 1.05 (95% CI 1.02–1.09; p < 0.01), respectively [13,16].…”

Section: Pathogenesismentioning

confidence: 99%

How Much Remnant Is Enough in Liver Resection?

Guglielmi¹,

Ruzzenente²,

Conci³

et al. 2012

Dig Surg

305

204

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Background: Liver resection represents the first choice of treatment for primary and secondary liver malignancies, offering the patient the best chance of long-term survival. The extensive use of major hepatectomy increases the risk of post-hepatectomy liver failure (PHLF), which is associated with a high frequency of postoperative complications, mortality and increased length of hospital stay. Aims: The aim of this review is to investigate the different risk factors related to the occurrence of PHLF and to identify the limits for a safe liver resection in patients with normal liver and injured liver (cirrhosis, cholestasis, steatosis and post-chemotherapy liver injury). Methods: A literature search was undertaken in PubMed and related search engines, looking for articles relating to hepatic failure following hepatectomy in normal liver or injured liver. Results: In spite of improvements in surgical and postoperative management, the parameters determining how much liver can be resected are still largely undefined. A number of preoperative, intraoperative and postoperative factors all contribute to the likelihood of liver failure after surgery. The safe limits for liver resection can be estimated from the data of the literature for patients with normal liver and for those with different types of liver injury. Conclusions: Preoperative assessment that includes evaluation of liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. The critical residual liver volume for patients able to predict PHLF is mainly related to the presence of pre-existing liver disease and liver function. Among patients with normal liver, the limit for safe resection ranges from 20 to 30% future remnant liver of total liver volume. In patients with injured liver (cirrhosis, cholestasis or steatosis), preoperative assessment of the risk of PHLF should include future remnant liver volumetry and accurate liver function evaluation, including different dynamic liver function tests.

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Section: Pathogenesismentioning

confidence: 99%

How Much Remnant Is Enough in Liver Resection?

Guglielmi¹,

Ruzzenente²,

Conci³

et al. 2012

Dig Surg

305

204

View full text Add to dashboard Cite

show abstract

“…As mentioned above, the posthepatectomy mortality reported in recent years varies between 0% and 5% and the onset of PHLF remains the main cause [10][11][12] . Factors that contribute to the onset of PHLF can be divided into three groups: patient-related factors (age, diabetes, obesity) [13,14] ; parenchyma-related factors (cirrhosis, cholestasis, steatosis, chemotherapy effects) [15][16][17] ; surgery-related factors (bleeding, ischemiareperfusion damage, sepsis, insufficient FLRV) [18][19][20][21] . With hepatic resection an amount of liver parenchyma is lost, and in the remnant hepatocytes arise both regeneration and necrosis.…”

Section: Introductionmentioning

confidence: 99%

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

D’Onofrio

Robertis

Demozzi

et al. 2014

WJR

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The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

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“…This is highlighted by the even more controversial topic of hepatic resection for elderly patients with HCC. 20 This form of treatment should be reconsidered because over the last 20 years, there has been a continuous improvement in survival after HCC resection, even in older patients. 21 A tumor that is resectable must be present together with adequate functional liver reserve for sustaining life (found mostly in patients with Child-Pugh status A but sometimes in patients with Child-Pugh status B); this makes this treatment subset of elderly patients with HCC even smaller than the other subgroups.…”

Section: See Article On Page 423mentioning

confidence: 99%

“…22 There is evidence that this subgroup may be increasing in some countries. 20 The survival rates of elderly patients with HCC who are able to undergo surgical resection has been reported to be 58% at 3 years and 46% at 5 years. 20 Another study has reported similar survival rates after HCC resection in the elderly: 54.6% at 3 years and 43.2% at 5 years.…”

Section: See Article On Page 423mentioning

confidence: 99%

“…20 The survival rates of elderly patients with HCC who are able to undergo surgical resection has been reported to be 58% at 3 years and 46% at 5 years. 20 Another study has reported similar survival rates after HCC resection in the elderly: 54.6% at 3 years and 43.2% at 5 years. 23 These outcomes might be somewhat better if the tumors were limited to only those meeting the Milan criteria and not just resectable tumors.…”

Section: See Article On Page 423mentioning

confidence: 99%

See 1 more Smart Citation

Treatment of an elderly patient with hepatocellular carcinoma: Counseling from the patient's point of view

Perkins

2012

Liver Transpl

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Prognosis of patients with hepatocellular carcinoma after hepatic resection: Are elderly patients suitable for surgery?

Abstract: Careful follow-up and proper decision on hepatectomy upon assessment of PRS are important in elderly HCC patients.

Cited by 83 publications

References 45 publications

How Much Remnant Is Enough in Liver Resection?

How Much Remnant Is Enough in Liver Resection?

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

Treatment of an elderly patient with hepatocellular carcinoma: Counseling from the patient's point of view

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