Safety of Liver Resection in the Elderly: How Important Is Age?

Cho, S. W.; Steel, Jennifer L.; Tsung, Allan; Marsh, J. Wallis; Geller, David A.; Gamblin, T. Clark

doi:10.1245/s10434-010-1404-6

Cited by 62 publications

(64 citation statements)

References 30 publications

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“…In our series, about 40% of patients that developed liver failure presented a preoperative diagnosis of diabetes. A recent study [43] showed that preoperative chemotherapy was associated with higher morbidity in the elderly, and similar results were reported by Adam et al [44]. These data are important because of an increasing number of patients who receive systemic chemotherapy as an integral part of multidisciplinary treatment for primary and metastatic liver cancers.…”

Section: Discussionsupporting

confidence: 64%

Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center

et al. 2010

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Recent advances in patient selection and surgical technique have resulted in low mortality and morbidity rates after liver resections. The aim of this study was to evaluate the operative risks of liver trisectionectomies in comparison with major resections. The data prospectively collected of patients who underwent trisectionectomies (TR Group, n = 54) and major hepatectomies (MH Group, n = 175) without biliary reconstruction were compared. Besides, the early results of patients who underwent right trisectionectomies (RTR Group, n = 36) and left trisectionectomies (LTR Group, n = 18) were compared. There was no significant difference in patient characteristics of MH and TR groups excluded for a high portal vein embolization (PVE) in TR group. Mortality (1% in MH group and 3.7% in TR group, p = 0.206) and overall morbidity rates (39% in MH group and 48% in TR group, p = 0.225) were similar between two groups. A higher proportion of patients in TR group developed liver failure (p = 0.024) and required blood transfusion (30 vs. 11%, p < 0.001). The median hospital stay after trisectionectomies was higher in TR group than MH group (p = 0.053). There was no significant difference in patient characteristics of LTR and RTR groups excluded for lymphadenectomy which was higher in LTR group (p = 0.008) and PVE rate higher in RTR group (p = 0.01). The overall morbidity (44 vs. 55%) and mortality (2.7 vs. 5.5%) were comparable between two groups. A higher proportion of patients in RTR group required blood transfusion (39 vs. 11%, p = 0.032). At multivariate analysis, age was the only positive predictor for morbidity after trisectionectomies (p = 0.010). Trisectionectomies can be performed safely. Left trisectionectomies are as safe as right trisectionectomies. The accurate preoperative selection is necessary to reduce operative risks.

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Section: Discussionsupporting

confidence: 64%

Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center

et al. 2010

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“…The increase in the elderly population and the increase in resectable patients, thanks to neoadjuvant treatment and advanced techniques, lead to frequently performing major surgeries in elderly patients. For this reason, treating cancer in elderly patients is one of the major challenges of modern oncology [7-14]. This multicentric study shows that in a total of 744 patients operated on for CRLM, 42 patients are older than 80.…”

Section: Discussionmentioning

confidence: 99%

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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“…With the current improvements in surgical techniques and perioperative care, major hepatic resection for HCC, mainly in the form of classical right or left hepatectomy, is associated with acceptable operative morbidity and mortality in selected patients with cirrhosis [11,26,27]. Some studies also demonstrate that major hepatectomy can be performed as safely in elderly patients as in younger patients [5,15,16,28]. However, there is a paucity of data in the literature on major resection for HCC in cirrhotic elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis

Wang

Zhu²,

Cheng³

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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With rigorous screening of patients and improvement of perioperative management and operative techniques, major hepatectomy can be safely performed on HCC patients aged 70 years or more with liver cirrhosis. Intraoperative red blood cell transfusion of 5 U or more was predictive of higher morbidity in the elderly. Surgeons should take care to minimize the likelihood of intraoperative blood transfusion in elderly patients.

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Safety of Liver Resection in the Elderly: How Important Is Age?

Cited by 62 publications

References 30 publications

Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center

Liver trisectionectomies for primary and secondary liver cancer in the modern era: results of a single tertiary center

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

Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis

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