Validation of hepatectomy for elderly patients with hepatocellular carcinoma

The safety and feasibility of hepatectomy for hepatocellular carcinoma (HCC) in the elderly population have not been defined to date.

A single-center, retrospective cohort study was conducted with 104 patients who underwent hepatectomy for HCC from 2005 to 2010. The patients were divided into two groups, the elderly group (age, ≥75 years; n = 22) and the nonelderly group (age, <75 years; n = 82), for comparison of short- and long-term outcomes.

More patients were categorized as preoperative Eastern Cooperative Oncology Group (ECOG) performance status 1 in the elderly group (32 %) than in the nonelderly group (6 %) (P = 0.003). Complications with a Clavien-Dindo classification of grade 3a or higher were more frequently observed in the elderly group (41 %) than in the nonelderly group (17 %) (P = 0.006). Multivariate logistic regression showed ECOG performance status 1 as the only independent predictor of complications classified as Clavien-Dindo grade 3a or higher. The in-hospital mortality rates were similar between the two groups (P = 0.20). During a median follow-up period of 47 months, the unadjusted 5-year recurrence-free survival rates were similar in the elderly (25 %) and nonelderly (33 %) groups (P = 0.80). Multiple tumors and high alpha-fetoprotein levels emerged as independent negative indicators of recurrence-free survival using multivariate Cox analyses. The adjusted risk for recurrence was not elevated in the elderly group (hazard ratio [HR], 0.92; 95 % confidence interval [CI] 0.50-1.68; P = 0.78).

Despite the more frequent occurrence of complications with a Clavien-Dindo grade of 3a or higher among the elderly patients undergoing hepatectomy for HCC, their mortality and recurrence rates were comparable with those of the nonelderly patients. Therefore, age alone is not a determinant of surgical candidacy for HCC.