Outcomes after major hepatectomy in elderly patients

Area of Science:

• Hepatobiliary Surgery
• Surgical Outcomes Research
• Geriatric Surgery

Background:

• Assessing the safety and efficacy of major liver resections in elderly patients (70+ years).
• Comparing outcomes of major liver resections in elderly versus younger patient cohorts.

Purpose of the Study:

• To evaluate early and long-term outcomes of major liver resections in patients aged 70 years and older.
• To compare these outcomes with those of patients younger than 70 years.

Main Methods:

• Retrospective analysis of 517 patients undergoing major liver resection (≥3 segments) between 1993 and 2004.
• Patients divided into two groups: 70 years and older (elderly, n=127) and younger than 70 years (young, n=390).
• Analysis of operative mortality, postoperative morbidity, overall survival, and disease-free survival.

Main Results:

• No significant differences in operative mortality (7.9% vs 5.4%) or postoperative morbidity between elderly and young groups.
• Overall survival (59% vs 57%) and disease-free survival (60% vs 55%) were comparable.
• For colorectal liver metastases subgroup, survival rates were also similar.
• Multivariable analysis identified American Society of Anesthesiologists grade 3 and >3 intraoperative transfusions as predictors for overall survival.
• More than three tumors and redo resection predicted disease-free survival.

Conclusions:

• Major liver resections are safe and effective in patients aged 70 years and older.
• Outcomes and survival rates are comparable to younger patients undergoing similar procedures.
• Predictors of survival include patient comorbidities and intraoperative factors like transfusion requirements.