Liver resection for hepatocellular carcinoma in octogenarians

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Geriatric Medicine

Background:

• Liver resection in patients aged 80 years and older presents unique challenges due to increased medical comorbidities and shorter life expectancies.
• The efficacy and safety of liver resection for hepatocellular carcinoma (HCC) in octogenarians remain subjects of ongoing investigation.

Purpose of the Study:

• To compare the outcomes of liver resection for HCC in octogenarian patients versus younger patient cohorts.
• To evaluate the feasibility and safety of surgical intervention in elderly individuals with HCC.

Main Methods:

• A retrospective analysis was conducted on 260 patients with HCC who underwent liver resection between 1991 and 1997.
• Patients were stratified into two groups: Group 1 (21 patients aged ≥80 years) and Group 2 (239 younger patients).
• Demographic, pathological, and operative data were compared between the two groups.

Main Results:

• Octogenarians exhibited a higher prevalence of comorbidities, lower hepatitis B surface antigen positivity, reduced alpha-fetoprotein levels, and impaired indocyanine green clearance.
• Despite longer postoperative hospital stays in octogenarians, operative morbidity and mortality rates were comparable between the groups.
• Five-year disease-free survival was 50.6% for octogenarians versus 35.3% for younger patients (P=.15), and actuarial survival was 40.9% versus 59.3% (P=.46), respectively.

Conclusions:

• Liver resection for HCC in carefully selected octogenarian patients is a justifiable procedure.
• With meticulous preoperative assessment and postoperative care, elderly patients can achieve short- and long-term outcomes similar to their younger counterparts.