title: Elderly and very elderly patients with hepatocellular carcinoma. Strategy for a first line treatment.
abstract: OBJECTIVE
  Health-status of elderly patients with hepatocellular carcinoma (HCC) may limit surgical approach; other options are thus auspicable.
  
  
  METHODS
  The authors reviewed 98 selected patients, aged 65 to 90 years, with 149 HCC treated between 2002 and 2011. According to the extent of malignancy, health status and treatment, patients were divided into 3 groups. Sixty-one, submitted to major and minor curative resections, were in group A and B while group C included 37 patients, unsuitable for high-risk procedures and percutaneous ablation, submitted to intraoperative-radiofrequency ablation (IRFA) alone or combined with minor resections. Assessment of safety and therapeutic efficacy of this managment was evaluated.
  
  
  RESULTS
  A postoperative mortality rate of 1,02% and an overall survival rate at 5 years of 62.3% were observed. Indeeed matched post-operative morbidity and mortality rates of A, B, C groups were 45%, 8%, 16.21% (p < 0.004) and 9 %, 0%, 0% (p= 0.112 ) respectively. 3 years overall-survival was not statistically different (p= 0.585). However 5 years survival rate and disease-free-survival rate were significantly higher in patients of group A and B (p= 0.003; p< 0.001).
  
  
  CONCLUSIONS
  Treatment strategies to minimize treatment-related morbidity and mortality have resulted satisfactory for early and late outcomes of an heterogeneous group of elderly patients with HCC.
authors.forename: Stefania
authors.initials: S
authors.lastname: Brozzetti
authors.forename: Mario
authors.initials: M
authors.lastname: Bezzi
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: De Sanctis
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Andreoli
authors.forename: Monica
authors.initials: M
authors.lastname: De Angelis
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Miccini
authors.forename: Francesca
authors.initials: F
authors.lastname: Galati
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
authors.forename: Caterina
authors.initials: C
authors.lastname: Furlan
authors.forename: Domenico
authors.initials: D
authors.lastname: De Santis
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
authors.forename: Adriano
authors.initials: A
authors.lastname: Tocchi
mesh_terms: D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D003952:Diagnostic Imaging; D019468:Disease Management; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome