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Oncological liver resection in elderly - A retrospective comparative study.

Carina E Riediger1, Steffen Löck2, Laura Frohneberg1

  • 1Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT/UCC), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden, Rossendorf (HZDR), Dresden, Germany.

International Journal of Surgery (London, England)
|June 27, 2022
PubMed
Summary

Liver resections in older adults (≥70 years) show higher morbidity and mortality. Parenchyma-sparing techniques are recommended for these patients to improve outcomes after liver surgery.

Keywords:
ElderlyLiver surgeryMorbidityMortalityRisk factors

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Area of Science:

  • Hepatobiliary surgery
  • Geriatric surgery
  • Surgical oncology

Background:

  • Increasing life expectancy leads to more liver resections in patients over 70.
  • Older age correlates with increased postoperative complications and mortality.
  • This study compares outcomes of liver resections in patients below and above 70 years old.

Purpose of the Study:

  • To compare postoperative outcomes of liver resections for malignancies in patients aged <70 and ≥70 years.
  • To identify risk factors associated with worse outcomes in older patients undergoing liver resection.

Main Methods:

  • Retrospective analysis of 889 liver resections from a prospectively collected database (2013-2019).
  • Comparative analysis between patients <70 years (n=582) and ≥70 years (n=307).
  • Uni- and multivariate analyses were performed to identify risk factors for postoperative outcomes.

Main Results:

  • Patients ≥70 years had significantly higher postoperative morbidity (27.9% overall) and mortality (3.9% overall) rates.
  • Major hepatectomies were more frequent in the ≥70 group (50.5% vs 42.8%).
  • Independent risk factors for worse outcomes included major resections, longer operating time, intraoperative transfusions, and biliodigestive anastomosis (BDA) or inferior vena cava (IVC) resection.

Conclusions:

  • Liver resections in patients aged ≥70 years are associated with a more challenging postoperative course.
  • Parenchyma-sparing resections are advised for elderly patients to mitigate risks.
  • Optimizing surgical strategies for older adults is crucial for improving liver resection outcomes.