title: Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery?
abstract: OBJECTIVE
  The indication for hepatectomy is still controversial in elderly patients with hepatocellular carcinoma (HCC). We examined the clinicopathological features and survival of 188 HCC patients who underwent hepatectomy.
  
  
  METHODS
  Patients were divided into four age groups: Age(<50) group (young patients <50 years of age, n = 9), Age(50-69) group (between 50-69 years, n = 110), Age(70-79) group (70-79 years, n = 57), and Age(≥80) group (≥80 years, n = 12). Physiologic ability and surgical stress (E-PASS) score, including preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were assessed.
  
  
  RESULTS
  Proportion of patients of Age(70-79) and Age(≥80) groups increased significantly in the last 5 years (P < 0.01). Co-morbidity, performance status, and American Society of Anesthesiologists score significantly increased with age (P < 0.05). Proportions of patients with irregular findings and necro-inflammatory activity were significantly lower in Age(70-79) and Age(≥80) groups than in other groups (P < 0.05). Systemic postoperative complications were high in Age(70-79) and Age(≥80) groups. PRS increased significantly with age (P < 0.05). Multivariate analysis identified PRS ≥0.32 and age ≥70 years as significant determinants of systemic complications (P < 0.05). There were no significant differences in postoperative survivals among the groups.
  
  
  CONCLUSIONS
  Careful follow-up and proper decision on hepatectomy upon assessment of PRS are important in elderly HCC patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan. a-nanasm@nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Takashi
authors.initials: T
authors.lastname: Nonaka
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Fukuoka
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutake
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate