title: The Influence of Aging on Hepatic Regeneration and Early Outcome after Portal Vein Occlusion: A Case-Control Study.
abstract: BACKGROUND
  Portal vein occlusion (PVO) is used to increase inadequate future liver remnant volume (FLRV). Impaired liver regeneration has been reported in aged animals. This study was designed to evaluate the impact of patient age on hepatic regeneration.
  
  
  METHODS
  Sixty patients aged ≥70 years were matched 1:1 with 60 patients aged <70 years. Matching criteria were sex, diabetes, cirrhosis, pre-PVO chemotherapy and bevacizumab administration, and jaundice.
  
  
  RESULTS
  The median ages in the older and younger groups were 76 (range 70-83) years and 59 (range 20-69) years, respectively (p < 0.001). Median FLRV following PVO (33.1 ± 6.8 vs. 31.9 ± 6.0 %) and volumetric increase (0.52 ± 0.35 vs. 0.49 ± 0.34) were similar in the two groups. Of the older and younger patients, 10 % and 1.7 %, respectively, did not undergo liver surgery after PVO (p = 0.051). Mortality (5.5 vs. 6.7 %) and major morbidity (25.9.8 vs. 22 %) rates were similar. Liver failure rate was higher in older patients (35.1 vs. 16.9 %, p < 0.026), mainly due to Grade A liver failure (20.3 vs. 8.4 %, p < 0.001). Multivariate analysis showed that age ≥ 70 years [odds ratio (OR) 3.03; 95 % confidence interval (CI) 1.18-7.78; p = 0.020] and biliary cancer diagnosis (OR 4.69; 95 % CI 1.81-12.09; p = 0.001) were independent risk factors for postoperative liver failure.
  
  
  CONCLUSIONS
  Liver regeneration after PVO is not impaired by age. Nevertheless, liver resection in elderly patients is performed less often after PVO and carries a higher risk of liver failure.
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy. nrussolillo@mauriziano.it.
authors.forename: Nadia
authors.initials: N
authors.lastname: Russolillo
authors.affiliation: Liver Unit, Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Liver Surgery Unit, Department of Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Viganò
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Langella
authors.affiliation: Liver Unit, Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Liver Unit, Department of Hepatobiliary Surgery, San Raffaele Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage; D001661:Biliary Tract Neoplasms / Q000150:complications / Q000628:therapy*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D048909:Diabetes Complications / Q000150:complications / Q000503:physiopathology; D004621:Embolization, Therapeutic; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D000077146:Irinotecan; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009929:Organ Size; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011169:Portal Vein; D011300:Preoperative Care; D011859:Radiography; D012737:Sex Factors; D055815:Young Adult
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin