Hepatic resection in the elderly

Between July 1, 1970 and December 31, 1988, 453 patients underwent hepatic resection by the senior author. Ninety of these patients were more than 64 years old and are the subject of this review. The 30-day operative mortality rate for all patients undergoing hepatic resection was 3.3%: major hepatic resection was 4.4% and subsegmental resection was 1.4%. The operative mortality rate for patients undergoing major hepatic resection increased incrementally with age: for patients up to age 55 years it was 0.70%, for those between 55 and 64 years it was 3.6%, and for patients older than 64 years it increased to 11.1%. This higher operative mortality rate in the elderly reflects the mortality rate for extended right hepatic lobectomy in this age group of 30.7%. If this procedure is excluded, the operative mortality rate for patients older than age 64 was 7.6%. Sixty per cent of the operative deaths were due to hepatic insufficiency. The data presented demonstrate that major hepatic resection can be performed in the elderly with a low but somewhat increased mortality risk. However, because of its markedly increased operative risk, extended right hepatic lobectomy should be performed in elderly patients only in selected cases until better methods of estimating hepatic reserve are available.