Liver resections in over-75-year-old patients: surgical hazard or current practice?
OBJECTIVE
To assess the safety of hepatic resections in the very old patient by comparing the outcome in patients younger and older than 75 years.


METHODS
Thirty-two resections in 31 patients > or =75 years (Over-75 Group) were compared with 164 resections in 162 patients <75 years (Control Group). Indications for resection, concomitant diseases, previous abdominal surgery, type of resection, associated surgical procedures, use/length of portal clamping, intra-operative blood losses and transfusions, and length of operation were preliminarily compared. The outcome was evaluated in terms of post-operative mortality, morbidity, transfusions, and postoperative hospitalization.


RESULTS
Mean age was 76.0 +/- 2.3 years (range 75-83) in the Over-75 Group and 58.4 +/- 10.7 years (range 23-74) in the Control Group. The over-75 group included more hepatomas (43.8% vs. 26.8%, P = 0.09), chronic liver disease (31.3% vs. 28.7%, P = 0.03) and concomitant diseases (62.5% vs. 32.9%, P = 0.002). The two groups were comparable (P = n.s.) when evaluated for all other variables. The 30-day mortality rate was 3.6% in the Control Group and none in the Over-75 Group. Postoperative surgical complications occurred in 37 patients (22.6%) in the Control Group and 1 patient (3.1%) in the Over-75 Group, with statistically significant differences (P = 0.01), and incidence of medical complications was 13.4% in the Control Group and 3.1% in the Over-75 Group. Median postoperative hospitalization and transfusions were not statistically different.


CONCLUSIONS
Hepatic resections in over-75-year-old patients are not a surgical hazard and may be carried out relatively safely as long as an accurate selection of the patient is performed.
Department of Surgery, Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University School of Medicine, Milan, Italy. aldrighetti.luca@hrs.it
Luca
L
Aldrighetti
Marcella
M
Arru
Marco
M
Catena
Renato
R
Finazzi
Gianfranco
G
Ferla
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome