Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis.
BACKGROUND
Because of an increasing aging population worldwide, a greater number of elderly patients are being considered for hepatic resection. The objective of this retrospective pair-matched study was to assess the influence of age on postoperative outcomes after major hepatectomy (resection of three or more Couinaud segments) in elderly patients with hepatocellular carcinoma (HCC) and cirrhosis.


METHODS
A retrospective review of patient demographics, diagnoses, surgical treatments, and early postoperative outcomes was performed.


RESULTS
A total of 208 HCC patients with cirrhosis underwent major hepatectomy between 2007 and 2012. The mortality rate was 3.57% in patients aged 70 years or more (group E) compared with 1.32% in those aged below 70 years (group Y; P=0.630). The overall complication rates were 53.57% in group E and 47.37% in group Y (P=0.427). Increasing age was independently associated with postoperative pneumonia (P<0.001), bacteremia (P=0.026), and respiratory failure requiring reintubation (P=0.028). A total of 25.00% of patients had a Clavien-Dindo classification grade of 3a or more in group E compared with 13.16% in group Y (P=0.040). In multivariate analysis, intraoperative red blood cell transfusion of 5 U or more (P=0.016; hazard ratio 4.812; 95% confidence interval 1.332-17.384) was a predictor of higher morbidity in the elderly.


CONCLUSIONS
With rigorous screening of patients and improvement of perioperative management and operative techniques, major hepatectomy can be safely performed on HCC patients aged 70 years or more with liver cirrhosis. Intraoperative red blood cell transfusion of 5 U or more was predictive of higher morbidity in the elderly. Surgeons should take care to minimize the likelihood of intraoperative blood transfusion in elderly patients.
aDepartment of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine bInstitute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an cDepartment of General Surgery, Bazhong Central Hospital, Bazhong, People's Republic of China.
Wan-Li
WL
Wang
Ying
Y
Zhu
Ji-Wen
JW
Cheng
Mu-Xing
MX
Li
Jian-Min
JM
Xia
Jie
J
Hao
Liang
L
Yu
Yi
Y
Lv
Zheng
Z
Wu
Bo
B
Wang
D000328:Adult; D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D017707:Erythrocyte Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000821:virology*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult