Hepatectomy for Hepatocellular Carcinoma in Elderly Patients Aged 75 Years or More

Oishi, Koichi; Itamoto, Toshiyuki; Kobayashi, Tsuyoshi; Oshita, Akihiko; Amano, Hodaka; Ohdan, Hideki; Tashiro, Hirotaka; Asahara, Toshimasa

doi:10.1007/s11605-008-0758-6

Cited by 70 publications

(67 citation statements)

References 21 publications

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“…Highvolume hospitals seem to be characterized by lesser morbidity and in-hospital mortality [55] . performed in the last 15 years indeed documented encouraging results [25,26,[34][35][36][37][38][39]42,[47][48][49][50] (Table 1). …”

Section: Resectionmentioning

confidence: 94%

“…In scientific literature on liver disease, and in particular in papers dealing with HCC, the most used threshold is 70 years [21][22][23] . More recently, clinical studies adopting a threshold of 75/80 years have been published [24][25][26] . The increasing age of the HCC population brings some drawbacks to HCC treatment, due to the occurrence of comorbidities which can be associated with reduced treatment tolerability and an increased risk of severe toxicity.…”

Section: Implicationmentioning

confidence: 99%

“…Data on survival and disease free survival in old and young patients undergoing HCC resection are reported in Table 1. Post-operative mortality in elderly patients was reported to range from 0 to 3.2% [25,[34][35][36][37][38][39][40][41][42][48][49][50][55][56][57] . In two retrospective studies from Far East, surgeryrelated in-hospital morbidity and mortality were not significantly different in older as compared to younger patient [26,50] .…”

Section: Resectionmentioning

confidence: 99%

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Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under-or no-treatment of aged patients should not be longer justified. Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic AbstractMean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific REVIEWSubmit a

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Section: Resectionmentioning

confidence: 94%

Section: Implicationmentioning

confidence: 99%

Section: Resectionmentioning

confidence: 99%

See 1 more Smart Citation

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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“…For example, right hemihepatectomy could be tolerated if ICGR 15 was in the normal range. One-third of the liver parenchyma could be resected for patients with ICGR 15 of 10-19%, segmentectomy was possible with ICGR 15 of 20-29%, and limited resection was possible with ICGR 15 of 30% and more [16]. The procedures of hepatectomy were the same as those described previously [17,18].…”

Section: Hepatic Resectionmentioning

confidence: 99%

Treatment strategy for early hepatocellular carcinomas: Comparison of radiofrequency ablation with or without transcatheter arterial chemoembolization and surgical resection

Tashiro

Aikata

Waki

et al. 2011

Journal of Surgical Oncology

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“…However, in most studies, the cut-off age is 70 years. [5–12] A significant reduction in liver mass and portal blood flow were demonstrated in patients aged 70 years or older, [13] but liver regeneration does not seem to be significantly affected by age. [14] …”

Section: Introductionmentioning

confidence: 99%

Impact of age on short-term outcomes of liver surgery

et al. 2017

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We investigate the surgical outcomes of patients undergoing hepatectomy according to different age intervals, identify the clinical factors related to surgical outcomes, and propose clinical risk scores for severe morbidity and mortality based on the clinical factors.Eight hundred three patients undergoing liver resection were divided into 3 groups: young patients (YP), <65 years (n = 387), elderly patients (EP), from 65 to 74 years (n = 279); very-elderly patients (VEP), ≥75 years (n = 137).Severe morbidity was 10.6%, 12.2%, and 17.5% (P = .103), and mortality was 0.3%, 1.4%, and 4.4% (P = .002) in group YP, EP, and VEP, respectively. Ischemic heart disease, cirrhosis, major hepatectomy, biliary tract-associated procedure, and red blood cells (RBC) transfusion ≥3 U were related with severe morbidity. Ischemic heart disease, cirrhosis, major hepatectomy, and RBC transfusion were independent risk factors for postoperative mortality. Age did not result an independent factor related to mortality and severe morbidity. Two different scores were developed and have proved to be statistically related with severe morbidity and mortality. Moreover, in patients with score ≥2, severe morbidity increased from 24.2% in YP, to 29.3% in EP, and to 40.0% in VEP, P = .047. Likewise, mortality increased from 2.3% in YP, to 7.0% in EP, and to 22.7% in VEP, in patients with score ≥2, P = .017.Age alone should not be considered a contraindication for hepatectomy. We identified factors and proposed 2 scores that can be useful to stratify the risk of morbidity and mortality after hepatectomy. Moreover, severe morbidity and mortality increases according to the different age intervals in patients with scores ≥2.

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Hepatectomy for Hepatocellular Carcinoma in Elderly Patients Aged 75 Years or More

Abstract: Hepatectomy for elderly patients with resectable HCC is safe and feasible. Selected elderly patients with HCC might benefit from hepatectomy.

Cited by 70 publications

References 21 publications

Management of hepatocellular carcinoma in the elderly

Management of hepatocellular carcinoma in the elderly

Treatment strategy for early hepatocellular carcinomas: Comparison of radiofrequency ablation with or without transcatheter arterial chemoembolization and surgical resection

Impact of age on short-term outcomes of liver surgery

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