Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis

Because of an increasing aging population worldwide, a greater number of elderly patients are being considered for hepatic resection. The objective of this retrospective pair-matched study was to assess the influence of age on postoperative outcomes after major hepatectomy (resection of three or more Couinaud segments) in elderly patients with hepatocellular carcinoma (HCC) and cirrhosis.

A retrospective review of patient demographics, diagnoses, surgical treatments, and early postoperative outcomes was performed.

A total of 208 HCC patients with cirrhosis underwent major hepatectomy between 2007 and 2012. The mortality rate was 3.57% in patients aged 70 years or more (group E) compared with 1.32% in those aged below 70 years (group Y; P=0.630). The overall complication rates were 53.57% in group E and 47.37% in group Y (P=0.427). Increasing age was independently associated with postoperative pneumonia (P<0.001), bacteremia (P=0.026), and respiratory failure requiring reintubation (P=0.028). A total of 25.00% of patients had a Clavien-Dindo classification grade of 3a or more in group E compared with 13.16% in group Y (P=0.040). In multivariate analysis, intraoperative red blood cell transfusion of 5 U or more (P=0.016; hazard ratio 4.812; 95% confidence interval 1.332-17.384) was a predictor of higher morbidity in the elderly.

With rigorous screening of patients and improvement of perioperative management and operative techniques, major hepatectomy can be safely performed on HCC patients aged 70 years or more with liver cirrhosis. Intraoperative red blood cell transfusion of 5 U or more was predictive of higher morbidity in the elderly. Surgeons should take care to minimize the likelihood of intraoperative blood transfusion in elderly patients.