Hepatic resection for hepatocellular carcinoma in the elderly

Area of Science:

• Hepatobiliary surgery
• Geriatric oncology
• Surgical oncology

Background:

• The global population is aging, leading to an increased number of elderly patients requiring surgical intervention for liver cancer (hepatocellular carcinoma).
• Surgical outcomes in elderly populations undergoing major procedures like hepatectomy for hepatocellular carcinoma require careful evaluation.

Purpose of the Study:

• To compare the surgical outcomes of hepatectomy for hepatocellular carcinoma in patients aged 70 years and older versus younger patients.
• To identify specific risk factors influencing outcomes in elderly patients undergoing liver cancer surgery.

Main Methods:

• A retrospective comparison of clinicopathological data and outcomes.
• 155 elderly patients (>/=70 years) and 333 younger patients with hepatocellular carcinoma who underwent hepatectomy between 1992 and 2007 were analyzed.

Main Results:

• Elderly patients exhibited a higher prevalence of comorbidities but demonstrated better preoperative liver function.
• Postoperative delirium was more frequent in the elderly group; however, operative morbidity, in-hospital mortality, disease-free survival, and overall survival showed no significant differences between groups.
• Elderly patients with a history of alcohol abuse had a significantly higher recurrence rate compared to younger patients with alcohol abuse, with preoperative alcohol abuse identified as a prognostic factor.

Conclusions:

• Hepatectomy for hepatocellular carcinoma demonstrates comparable short-term and long-term results for both elderly and younger patient cohorts.
• Elderly patients with preoperative alcohol abuse require close monitoring post-surgery, even after complete tumor resection (R0), due to the strong association with recurrence and reduced survival.