The survival paradox of elderly patients after major liver resections.
OBJECTIVE
The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis.


METHODS
From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years.


RESULTS
Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p = 0.017 and 47% versus 31%, p = 0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p = 0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival.


CONCLUSIONS
This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.
Ijtsma
Alexander J C
AJ
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, P.O. Box 30.001, The Netherlands. a.j.c.ijtsma@chir.umcg.nl
Boevé
Liselotte M S
LM
van der Hilst
Christian S
CS
de Boer
Marieke T
MT
de Jong
Koert P
KP
Peeters
Paul M J G
PM
Gouw
Annet S H
AS
Porte
Robert J
RJ
Slooff
Maarten J H
MJ
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D006498:Hepatectomy; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome