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Liver resection in the elderly

Y Fong1, M F Brennan, A M Cohen

  • 1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

The British Journal of Surgery
|November 15, 1997
PubMed
Summary
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Hepatic resection in elderly patients (over 65) shows a 4% mortality rate, challenging previous high-risk perceptions. This study demonstrates safe outcomes for major liver surgery in older adults.

Area of Science:

  • Hepatobiliary surgery
  • Geriatric surgery
  • Surgical oncology

Background:

  • Elderly patients undergoing major hepatic resection previously faced high operative mortality rates, potentially up to 40% for extended resections.
  • Limited healthcare resources necessitate rigorous evaluation of surgical interventions in older populations.

Purpose of the Study:

  • To prospectively assess the safety and outcomes of major hepatic resection in patients over 65 years of age.
  • To evaluate the morbidity and mortality associated with liver resection in the elderly population.

Main Methods:

  • A prospective study of 133 consecutive hepatic resections in patients aged 65 years and older over a 30-month period.
  • Analysis included overall mortality, hospital stay, intensive care unit (ICU) admissions, predictors of complications, and survival rates.

Related Experiment Videos

  • Outcomes were compared with a cohort of 244 younger patients (<65 years) undergoing liver resection during the same interval.

    • Main Results:

    • The overall mortality rate for hepatic resection in patients over 65 was 4%, significantly lower than previously reported figures.
    • Male sex, preoperative jaundice, abnormal electrocardiogram, and poor American Society of Anesthesiologists (ASA) physical status were predictors of cardiopulmonary complications (multivariate analysis identified male sex and ASA status).
    • Survival rates at 1, 2, and 3 years were 78%, 66%, and 50%, respectively, with all survivors returning to good functional status (Karnofsky score 95).
    • Older patients had a slightly longer mean hospital stay (13 days) compared to younger patients (11.9 days), P=0.02.

    Conclusions:

    • Major hepatic resection can be performed in patients over 65 years old with acceptable morbidity and mortality rates.
    • The findings support the feasibility and safety of liver resection in the elderly, challenging prior assumptions of high operative risk.