Liver resection in the elderly: significance of comorbidities and blood loss.
OBJECTIVE
Liver resection is increasingly performed in elderly patients who are suspected of increased postoperative morbidity (PM) and reduced overall survival (OS). Patient selection based on the identification of age-adjusted risk factors may help to decrease PM and OS.


METHODS
Prospectively collected data of 879 patients undergoing elective hepatic resection were analyzed. This population was stratified into three age cohorts: >70 years (n = 228; 26 %), 60-69 years (n = 309; 35 %), and <60 years (n = 342; 39 %). Multivariate survival analysis was performed.


RESULTS
The incidence of severe (p < 0.01) and non-surgical (p < 0.001) postoperative complications was higher in older compared to younger patients. Major estimated blood loss (EBL; p = 0.039) and comorbidities (p = 0.002) independently increased PM. EBL was comparable between all age cohorts. However, preexisting comorbidities, major EBL, and postoperative complications markedly decreased OS in contrast to younger patients. Adjusted for age, independent predictors of OS were comorbidities (HR = 1.51; p = 0.001), major hepatectomy (HR = 1.33; p = 0.025), increased EBL (HR = 1.32; p = 0.031), and postoperative complications (HR = 1.64; p < 0.001).


CONCLUSIONS
Although increased age should not be a contraindication for liver resection, this study accents the avoidance of major blood loss in elderly patients and a stringent patient selection based on preexisting comorbidities.
Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
Tobias S
TS
Schiergens
Carsta
C
Stielow
Stefanie
S
Schreiber
Cyrill
C
Hornuss
Karl-Walter
KW
Jauch
Markus
M
Rentsch
Wolfgang E
WE
Thasler
D054058:Acute Coronary Syndrome / Q000209:etiology; D000367:Age Factors; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D016063:Blood Loss, Surgical; D001810:Blood Volume; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D015897:Comorbidity; D017707:Erythrocyte Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011014:Pneumonia / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D015996:Survival Rate