Liver resection in the elderly

The operative mortality rate for hepatic resection in the elderly has been reported to be as high as 40 per cent for extended resection.

An increasing need to justify use of limited healthcare resources prompted a prospective assessment of 133 consecutive hepatic resections performed in 30 months in patients over 65 years of age.

The overall mortality rate was 4 per cent. Mean(s.e.m.) hospital stay was 13(1) days, and admission to the intensive care unit was required for only eight patients. By univariate analysis, male sex (P = 0.003), preoperative jaundice (P = 0.01), abnormal preoperative electrocardiogram (P = 0.05) and poor American Society of Anesthesiologists (ASA) physical status classification (P = 0.01) were predictors of cardiopulmonary complications. In a multivariate analysis only male sex and ASA classification predicted complications (P = 0.05). The 1-, 2- and 3-year survival rates for the entire group were 78, 66 and 50 per cent respectively. All survivors returned to good functional status (mean(s.e.m.) peak postoperative Karnofsky score 95(1)). When outcome was compared with that in 244 patients younger than 65 years of age who had liver resection during the same interval, the only difference was a longer mean hospital stay for the older patients: mean(s.d.) 13.4(0.5) versus 11.9(0.4) days for those aged less than 65 years (P = 0.02).

Major hepatic resection can be performed in patients over 65 years old with acceptable morbidity and mortality rates.