Liver resection for hepatocellular carcinoma in elderly patients: does age matter?
Elderly patients
Hepatocellular carcinoma
Liver resection
Survival
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
05 Sep 2024
05 Sep 2024
Historique:
received:
27
04
2024
accepted:
08
08
2024
medline:
6
9
2024
pubmed:
6
9
2024
entrez:
5
9
2024
Statut:
epublish
Résumé
Evaluation of the influence of the age of the patients upon the outcomes of liver resection (LR) for hepatocellular carcinoma (HCC). HCC patients who underwent LR between 2010 and 2020 were analyzed. They were divided into 3 groups depending on the patient's age. Group I (patients less than 60 years), Group II (patients between 60 and 69 years), and Group III (patients equal to or more than 70 years). 364 patients were included. A significantly higher serum bilirubin and alpha feto-protein were noted in Group I and serum creatinine was noted in Group III. The study groups did not show any significant differences regarding HCC site, number, macrovascular invasion, the extent of LR, Pringle maneuver, and perioperative blood transfusions. Longer operation time was found in Groups II and III, while more blood loss was noted in Group (I) Group I patients had longer hospital stays. Higher postoperative morbidities were noted in both Group I and Group (II) Higher incidence of post-hepatectomy liver dysfunction was noted in Group I. More early mortalities were found in Group I, related to liver failure. We did not experience early mortality in Group (III) Late Mortalities occurred in 117 patients (32.1%). HCC recurrence occurred in 165 patients (45.3%). Regarding the overall- and tumor-free survival, we did not experience any significant differences among the 3 groups (Log Rank: p = 0.371 and 0.464 respectively). Curative LR can be safely performed in selected elderly patients with HCC. An advanced patient's age should not be considered as a contraindication for curative LR.
Sections du résumé
BACKGROUND
BACKGROUND
Evaluation of the influence of the age of the patients upon the outcomes of liver resection (LR) for hepatocellular carcinoma (HCC).
METHODS
METHODS
HCC patients who underwent LR between 2010 and 2020 were analyzed. They were divided into 3 groups depending on the patient's age. Group I (patients less than 60 years), Group II (patients between 60 and 69 years), and Group III (patients equal to or more than 70 years).
RESULTS
RESULTS
364 patients were included. A significantly higher serum bilirubin and alpha feto-protein were noted in Group I and serum creatinine was noted in Group III. The study groups did not show any significant differences regarding HCC site, number, macrovascular invasion, the extent of LR, Pringle maneuver, and perioperative blood transfusions. Longer operation time was found in Groups II and III, while more blood loss was noted in Group (I) Group I patients had longer hospital stays. Higher postoperative morbidities were noted in both Group I and Group (II) Higher incidence of post-hepatectomy liver dysfunction was noted in Group I. More early mortalities were found in Group I, related to liver failure. We did not experience early mortality in Group (III) Late Mortalities occurred in 117 patients (32.1%). HCC recurrence occurred in 165 patients (45.3%). Regarding the overall- and tumor-free survival, we did not experience any significant differences among the 3 groups (Log Rank: p = 0.371 and 0.464 respectively).
CONCLUSIONS
CONCLUSIONS
Curative LR can be safely performed in selected elderly patients with HCC. An advanced patient's age should not be considered as a contraindication for curative LR.
Identifiants
pubmed: 39237941
doi: 10.1186/s12893-024-02528-7
pii: 10.1186/s12893-024-02528-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
248Informations de copyright
© 2024. The Author(s).
Références
Quaglia A, Tavilla A, Shack L, et al. The cancer survival gap between elderly and middle-aged patients in Europe is widening. Eur J Cancer. 2009;45(6):1006–16.
doi: 10.1016/j.ejca.2008.11.028
pubmed: 19121578
Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–7.
doi: 10.1097/01.SLA.0000081085.98792.3d
pubmed: 12894008
pmcid: 1422682
Ikai I, Kudo M, Arii S, et al. Report of the 18th follow-up survey of primary liver cancer in Japan. Hepatol Res. 2010;40:1043–59.
doi: 10.1111/j.1872-034X.2010.00731.x
pubmed: 34818831
Nanashima A, Abo T, Nonaka T, et al. Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery? J Surg Oncol. 2011;104:284–91.
doi: 10.1002/jso.21932
pubmed: 21462192
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.
Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer Incidence and Mortality Rates and trends and Update. Cancer Epidemiol Biomarkers Prev. 2016;25(1):16–27.
Hwang S, Lee YJ, Kim KH et al. The impact of tumor size on long-term survival outcomes after resection of solitary hepatocellular carcinoma: single-institution experience with 2558 patients. J Gastrointest Surg. 2015;19(7):1281–90.
Shehta A, Farouk A, Fouad A, et al. Post-hepatectomy liver failure after hepatic resection for hepatocellular carcinoma: a single center experience. Langenbeck’s Archives Surg. 2021;406(1):87–98.
doi: 10.1007/s00423-020-01956-2
El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134(6):1752–63.
doi: 10.1053/j.gastro.2008.02.090
Mizuguchi T, Kawamoto M, Meguro M, et al. Impact of aging on morbidity and mortality after liver resection: a systematic review and meta-analysis. Surg Today. 2015;45:259–70.
doi: 10.1007/s00595-014-0863-y
pubmed: 24526292
Hung AK, Guy J. Hepatocellular carcinoma in the elderly: meta-analysis and systematic literature review. World J Gastroenterol. 2015;21:12197–210.
doi: 10.3748/wjg.v21.i42.12197
pubmed: 26576104
pmcid: 4641137
Zhou Y, Zhang X, Zhang Z, et al. Hepatectomy in elderly patients: does age matter? World J Surg. 2013;37:2899–910.
doi: 10.1007/s00268-013-2184-5
pubmed: 23959339
Xing H, Liang L, Wang H, Zhou YH, Pei YL, Li C, et al. Multicenter analysis of long-term oncologic outcomes of hepatectomy for elderly patients with hepatocellular carcinoma. HPB. 2020;22:1314–23.
doi: 10.1016/j.hpb.2019.12.006
pubmed: 31980306
Thane P. The muddled history of retiring at 60 and 65. New Soc. 1978;45:234–6.
World Health Organization. Global Health Observatory Data, Egypt: country profiles. http://www.who.int/countries/egy/en/
Global Health Observatory Data Repository: Life expectancy - Data by country (CSV). Geneva, Switzerland: World Health Statistics 2015, World Health Organization, WHO., 2015. The technical health information is based on data accurate with respect to the year indicated (2013). http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy/
Wahab MA, Shehta A, Hamed H, El Nakeeb A, Salah T. Predictors of recurrence in hepatitis C virus related hepatocellular carcinoma after hepatic resection: a retrospective cohort study. Eurasian J Med. 2014;46(1):36.
Shehta A, Farouk A, Elghawalby AN, et al. Outcomes of hepatic resection for hepatocellular carcinoma associated with portal vein invasion. J Surg Res. 2021;266:269–83.
doi: 10.1016/j.jss.2021.04.011
pubmed: 34038849
Shehta A, Farouk A, Said R, et al. Bile leakage after hepatic resection for hepatocellular carcinoma: does it impact the short-and long-term outcomes? J Gastrointest Surg. 2022;26(10):2070–81.
doi: 10.1007/s11605-022-05433-7
Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcomes. Br J Anaesth. 1996;77:217–22.
doi: 10.1093/bja/77.2.217
pubmed: 8881629
Terminology Committee of the International Hepato-Pancreato- Biliary Association. The IHPBA Brisbane 2000 terminology of liver anatomy and resections. HPB Surg. 2000;2:333–9.
doi: 10.1016/S1365-182X(17)30755-4
Elhanafy E, Aboelinin M, Said R, et al. Outcomes of liver resection for huge hepatocellular carcinoma exceeding 10 cm in size: a single center experience. Am J Surg. 2023;225(6):1013–21.
doi: 10.1016/j.amjsurg.2022.12.005
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Rahbari NN, Garden OJ, Padbury R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver surgery (ISGLS). Surgery. 2011;149:713–24.
doi: 10.1016/j.surg.2010.10.001
pubmed: 21236455
Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver surgery. Surgery. 2011;149:680–8.
doi: 10.1016/j.surg.2010.12.002
pubmed: 21316725
Rahbari NN, Garden OJ, Padbury R et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS). HPB. 2011;13(8):528–35.
Waked I, Esmat G, Elsharkawy A, et al. Screening and treatment program to eliminate hepatitis C in Egypt. N Engl J Med. 2020;382:1166–74.
doi: 10.1056/NEJMsr1912628
pubmed: 32187475
Blum HE. Hepatocellular carcinoma: therapy and prevention. World J Gastroenterol. 2005;11:7391–400.
pubmed: 16437707
pmcid: 4725160
Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.
doi: 10.1002/hep.24199
pubmed: 21374666
Dedinská I, Laca L, Miklusica J, Palkoci B, Skálová P, Lauková S, Osinová D, Strmenová S, Janík J, Mokán M. Complications of liver resection in geriatric patients. Ann Hepatol. 2017;16(1):149–56.
doi: 10.5604/16652681.1226934
pubmed: 28051804
Laporte GA, Kalil AN. Liver resection in eldery patients. ABCD Arq Bras Cir Dig. 2013;26:136–9.
doi: 10.1590/S0102-67202013000200014
pubmed: 24000028
El Nakeeb A, Atef E, El Hanafy E, et al. Outcomes of pancreaticoduodenectomy in elderly patients. Hepatobiliary & Pancreatic Diseases International. 2016;15(4):419–27.
Tsujita E, Utsunomiya T, Ohta M, et al. Outcome of repeat hepatectomy in patients with hepatocellular carcinoma aged 75 years and older. Surgery. 2010;147(5):696–703.
doi: 10.1016/j.surg.2009.10.054
Ueno M, Hayami S, Tani M, Kawai M, Hirono S, Yamaue H. Recent trends in hepatectomy for elderly patients with hepatocellular carcinoma. Surg Today. 2014;44(9):1651–9.
Kishida N, Hibi T, Itano O, et al. Validation of hepatectomy for elderly patients with hepatocellular carcinoma. Ann Surg Oncol. 2015;22(9):3094–101.
doi: 10.1245/s10434-014-4350-x
pubmed: 25582743
Kaibori M, Matsui K, Ishizaki M, et al. Hepatic resection for hepatocellular carcinoma in the elderly. J Surg Oncol. 2009;99:154–60.
doi: 10.1002/jso.21221
pubmed: 19123236
Kondo K, Chijiiwa K, Funagayama M, Kai M, Otani K, Ohuchida J. Hepatic resection is justified for elderly patients with hepatocellular carcinoma. World J Surg. 2008;32:2223–9.
doi: 10.1007/s00268-008-9688-4
pubmed: 18642042
Sanyal S, Kron P, Wylie N, Hildalgo E, Toogood GJ, Lodge P. Outcomes of liver resection for hepatocellular carcinoma in octogenarians. HPB. 2020;22(9):1324–9.
Wu FH, Shen CH, Luo SC, et al. Liver resection for hepatocellular carcinoma in oldest old patients. World J Surg Oncol. 2019;17(1):1.
doi: 10.1186/s12957-018-1541-0
pubmed: 30606220
pmcid: 6317186
Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Uesaka K. The short- and long-term outcomes in elderly patients with hepatocellular carcinoma after curative surgery: a case-controlled study with propensity score matching. Eur Surg Res. 2018;59:380–90.
doi: 10.1159/000494733
pubmed: 30554221
Santambrogio R, Barabino M, Scifo G, Costa M, Giovenzana M, Opocher E. Effect of age (over 75 years) on postoperative complications and survival in patients undergoing hepatic resection for hepatocellular carcinoma. J Gastrointest Surg. 2017;21(4):657–65.
doi: 10.1007/s11605-016-3354-1
pubmed: 28083840
Ferrero A, Viganò L, Polastri R, et al. Hepatectomy as treatment of choice for hepatocellular carcinoma in elderly cirrhotic patients. World J Surg. 2005;29:1101–5.
doi: 10.1007/s00268-005-7768-2
pubmed: 16088422
Fukushima K, Fukumoto T, Kuramitsu K, et al. Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma. J Gastrointest Surg. 2014;18(4):729–36.
doi: 10.1007/s11605-013-2423-y
pubmed: 24297653
Yeh CN, Lee WC, Jeng LB, Chen MF. Hepatic resection for hepatocellular carcinoma in elderly patients. Hepatogastroenterology. 2004;51:219–23.
pubmed: 15011868
Fujii H, Itoh Y, Ohnishi N, et al. Factors associated with the overall survival of elderly patients with hepatocellular carcinoma. World J Gastroenterol. 2012;18:1926–32.
doi: 10.3748/wjg.v18.i16.1926
pubmed: 22563173
pmcid: 3337568
Kamath PS, Wiesner RH, Malinchoc M. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.
doi: 10.1053/jhep.2001.22172
pubmed: 11172350