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Published on: March 10, 2023
Hepatic resection is justified for elderly patients with hepatocellular carcinoma
Kazuhiro Kondo1, Kazuo Chijiiwa, Mayumi Funagayama
1Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, 5200 Kihara, Kiyotake, Miyazaki, Japan.
Insights
Hepatic resection for hepatocellular carcinoma (HCC) is safe and effective for patients aged 70 and older, showing similar outcomes to younger patients. This supports surgical intervention for selected elderly individuals with HCC.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Geriatric medicine
Background:
- Hepatocellular carcinoma (HCC) is a common liver cancer.
- Hepatic resection is a primary treatment for HCC.
- Elderly patients often avoid surgery due to perceived risks.
Purpose of the Study:
- To evaluate the safety and efficacy of hepatic resection in elderly patients (≥70 years) with HCC.
- To compare surgical outcomes between elderly and younger HCC patients.
Main Methods:
- Retrospective study of 294 patients undergoing 319 hepatic resections for HCC.
- Patients divided into two groups: ≥70 years (n=109) and <70 years (n=210).
- Comparison of postoperative complications (Clavien system), survival rates (JIS scores), and HCC-related death rates.
Main Results:
- No significant differences in postoperative complications or severity between age groups.
- Similar postoperative survival rates and HCC-related death rates across both age groups.
- Differences noted in performance status and hepatitis virus infection types.
Conclusions:
- Hepatic resection is a viable and safe treatment option for selected elderly patients (≥70 years) with HCC.
- Surgical indications for younger HCC patients are applicable to the elderly.
- Outcomes suggest elderly patients can benefit from hepatic resection without increased risk.
Background:
Hepatic resection is one of the main treatment modalities for patients with hepatocellular carcinoma (HCC); however, surgery is generally stressful and often is avoided for elderly patients. This retrospective study was designed to determine whether the indications for hepatic resection in younger patients with HCC are applicable to elderly patients.
Methods:
Subjects were 294 patients in whom 319 hepatic resections were performed for HCC (male/female ratio, 238/81; age range, 18-83 years). The patients were divided into two groups according to age at the time of surgery: 70 years or older (n = 109) and 69 years or younger (n = 210). Surgical strategy and postoperative follow-up methods did not differ between groups. The incidence and severity of postoperative complications classified by the Clavien system were compared between the two groups. Postoperative survival was compared between the two groups and between subgroups based on Japan Integrated Staging (JIS) scores. HCC-related death rates also were compared.
Results:
No significant between-group difference was found in background liver function or type of hepatic resection. Differences were found in performance status and type of hepatitis virus infection. No difference was observed in the incidence or severity of postoperative complications. Postoperative survival was similar between the two age-based study groups and between the JIS-based subgroups. HCC-related death rates did not differ between groups.
Conclusions:
The absence of differences in postoperative outcomes between groups suggests that hepatic resection is justified for HCC in selected patients aged 70 years or older.
