Right hepatic lobectomy in elderly patients with hepatocellular carcinoma.
OBJECTIVE
The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated.


METHODS
Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared.


RESULTS
No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%).


CONCLUSIONS
The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.
Yamamoto
K
K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Takenaka
K
K
Matsumata
T
T
Shimada
M
M
Itasaka
H
H
Shirabe
K
K
Sugimachi
K
K
D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000378:metabolism; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007202:Indicators and Reagents; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009930:Organic Chemicals; D010713:Phosphatidylcholines; D014176:Protein Biosynthesis; D002785:Sterol O-Acyltransferase / Q000032:analysis; D016896:Treatment Outcome
D007202:Indicators and Reagents; D009930:Organic Chemicals; D010713:Phosphatidylcholines; C013014:hepaplastin; D002785:Sterol O-Acyltransferase