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Hepatic resection in the elderly

T Koperna1, M Kisser, F Schulz

  • 1Department of General Surgery, Hospital Lainz, Vienna, Austria.

World Journal of Surgery
|April 2, 1998
PubMed
Summary
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Hepatic resections in elderly patients (>65) show high mortality for gallbladder cancer and primary liver cancer, especially with severe liver dysfunction. Preoperative assessment of liver and lung function is crucial for patient selection and reducing risks.

Area of Science:

  • Hepatobiliary Surgery
  • Geriatric Surgery
  • Surgical Oncology

Background:

  • Elderly patients (>65 years) undergoing hepatic resections present unique challenges due to age-related physiological changes.
  • Hepatic resections are performed for primary liver neoplasms, gallbladder cancer, and liver metastases.

Purpose of the Study:

  • To evaluate the outcomes of hepatic resections in elderly patients.
  • To identify risk factors for mortality and morbidity in this population.
  • To determine the safety and efficacy of major hepatic resections in older adults.

Main Methods:

  • Retrospective analysis of 97 patients aged >65 years who underwent hepatic resections between 1986 and 1995.
  • Data collected included patient demographics, diagnosis, resection extent, intraoperative details, postoperative complications, and survival.

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  • Statistical analysis was performed to identify factors influencing outcomes, including age, liver function, pulmonary function, and extent of resection.

    • Main Results:

    • Overall mortality varied by diagnosis: 2.5% for metastatic disease, 23% for primary liver cancer, and 25% for gallbladder cancer.
    • Severe liver dysfunction and older age (>80 years) significantly increased postoperative mortality and morbidity.
    • Pneumonia was the most frequent complication, and its occurrence, especially as a late complication, was associated with a high mortality rate.
    • The Goris score effectively predicted postoperative mortality, with higher scores indicating increased risk.

    Conclusions:

    • Severe liver dysfunction, rather than the extent of resection, is the primary determinant of clinical mortality in elderly patients undergoing hepatic resection.
    • Major hepatic resections for gallbladder cancer and primary liver neoplasia in the elderly are associated with high mortality and should be carefully considered.
    • Preoperative assessment of liver and pulmonary function is essential for patient selection, particularly for extensive resections, to minimize postoperative morbidity and mortality.
    • Elderly patients, especially those over 80, are more susceptible to postoperative organ failure and complications, necessitating cautious surgical decision-making.