title: Functional hepatocellular regeneration in elderly patients undergoing hepatectomy.
abstract: OBJECTIVE
  More than 50% of liver tumours occur in patients aged 65 years or more. Assessment of functional liver regeneration capacity is crucial to minimize postoperative liver failure. We aimed to study functional hepatocellular regeneration, through scintigraphic quantification of Mebrofenin hepatic extraction fraction (HEF), after partial hepatectomy, comparing elderly patients with younger ones.
  
  
  METHODS
  One hundred and two patients undergoing partial hepatectomy for primary or secondary hepatic lesions were prospectively included and divided in two groups: Group A - 58 patients aged <65 years (33 men, 53.9 ± 8.7 years), Group B - 44 patients aged ≥65 years (32 men, 71 ± 5 years). Groups were comparable in several aspects except for the presence of cirrhosis (more common in Group B, all patients Child-Pugh score A) and the initial diagnosis (Group B - primary lesions, Group A - metastases). The scintigraphic evaluation of Mebrofenin-HEF was performed before surgery, on the 5th and 30th day post-hepatectomy.
  
  
  RESULTS
  Mortality and morbidity were 3.4 and 12.1%, respectively, in Group A and 2.3 and 11.4% in Group B (n.s.). HEF values (%), T1/2 (min) and Tmax (min) showed no significant differences between the two groups: Group A (preoperative: HEF = 99.2 ± 1.5%, T1/2 = 36.7 ± 21.3, Tmax = 15 ± 6. Day 5: HEF = 96.3 ± 10.8%, T1/2 = 76.4 ± 75.9; Tmax = 13.3 ± 4.9. Day 30: HEF = 98.4 ± 5.5%, T1/2 = 38.6 ± 7.7, Tmax = 12.8 ± 3.6) and Group B (preoperative: HEF = 95.3 ± 13%, T1/2 = 38.1 ± 24.1; Tmax = 15.9 ± 9.4. Day 5: HEF = 98.4 ± 2.6%, T1/2 = 106.6 ± 131.7; Tmax = 15.1 ± 6.2. Day 30: HEF = 99 ± 2.1%, T1/2 = 40.5 ± 27; Tmax = 15.5 ± 6.7).
  
  
  CONCLUSIONS
  Our results suggest that functional hepatocellular regeneration is early, fast and similar between elderly and younger patients. Thus, age alone, does not appear to represent an absolute contraindication to hepatectomy.
authors: Gastroenterology Department, Coimbra University Hospital, Coimbra, Portugal.
authors: Alexandra I
authors: AI
authors: Fernandes
authors: José G
authors: JG
authors: Tralhão
authors: Ana
authors: A
authors: Abrantes
authors: Emir
authors: E
authors: Hoti
authors: Henrique
authors: H
authors: Alexandrino
authors: Bárbara
authors: B
authors: Oliveiros
authors: Margarida
authors: M
authors: Ferreira
authors: Maria F
authors: MF
authors: Botelho
authors: Francisco C
authors: FC
authors: Sousa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds; D005260:Female; D005998:Glycine; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007098:Imino Acids; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine
keywords: elderly patients; hepatectomy; hepatobiliary scintigraphy; hepatocellular regeneration