Hepatic Resection for Hepatocellular Carcinoma in The Elderly

Hanazaki, Kazuhiro; Kajikawa, Shoji; Shimozawa, Nobuhiko; Shimada, Kinji; Hiraguri, Manabu; Koide, Naoki; Adachi, Wataru; Amano, Jun

doi:10.1016/s1072-7515(00)00778-x

Cited by 108 publications

(76 citation statements)

References 24 publications

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“…Previous studies addressing this issue have compared cohorts of elderly patients with younger patients treated in the same time period (Table 5). [6][7][8][9][10][11]18 However, comparing cohorts introduces a potential selection bias due to heterogeneity of patients and operative characteristics. In order to maximally reduce selection bias in this study, a matched control analysis was performed to ensure comparison of elderly and younger patients with the same diagnosis and the same extent of liver resection.…”

Section: Discussionmentioning

confidence: 99%

“…5 Nevertheless, several observational cohort studies addressed this issue and have failed to show age to be an independent risk factor influencing short-and long-term survival after liver resections. [6][7][8][9][10][11] These observational cohort studies included a mix of wedge, minor, and major liver resections, and retrospectively compared study groups based on patient age at the time of liver resection. This study design may include a selection bias in terms of diagnosis and magnitude of liver resection.…”

Section: Introductionmentioning

confidence: 99%

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The Survival Paradox of Elderly Patients After Major Liver Resections

IJtsma

Boevé

Hilst

et al. 2008

Journal of Gastrointestinal Surgery

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Objective The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. Patients and Methods From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Results Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. Conclusion This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Survival Paradox of Elderly Patients After Major Liver Resections

IJtsma

Boevé

Hilst

et al. 2008

Journal of Gastrointestinal Surgery

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“…It should be noted that these data categorise patients according to the primary liver disease specified at the time of listing; this has the important implication that the 'HCC' category represents a minority of patients with tumours on 176,178,179,190,193,[415][416][417][418][419][420][421] • 11 insufficient sample size (n < 50) 171,172,186,205,411,[422][423][424][425][426][427] • Four included a substantial proportion of non-cirrhotic cases 155,165,428,429 • Five included a substantial proportion of large tumours (>5 cm) 166 …”

Section: Waiting List For Liver Transplantationmentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

151

108

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. Declared competing interests of authors: K Stein received an unrestricted grant from Schering Plough (UK) to carry out work on the cost-effectiveness of combination therapy for hepatitis C in 2000. KS is also a member of the editorial board for Health Technology Assessment, but he was not involved in the editorial process for this report. M Cramp sits on hepatitis C advisory boards for Schering Plough, Gilead and Roche. He has received unrestricted educational grants from Roche and Schering Plough to support research and service development. He has been awarded an NHS R&D grant looking at injecting drug users who do not have hepatitis C virus infection. J Thompson Coon received a grant from the Hepatitis C Trust to conduct a systematic review of complementary and alternative therapies for the treatment of chronic hepatitis C. HTA Published September 2007This report should be referenced as follows: NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) programme, now part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the costs, effectiveness and broader impact of health technologies for those who use, man...

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“…Hanazaki et al [21] also observe that cirrhosis and vascular invasion predict long term survival in patients older than 70 years. Vauthey et al [6] also confirm vascular invasion as a predictive factor for long term outcome but do not observe any significant correlation among survival and the presence of cirrhosis, grading, tumor dimension larger than 5 cm and free margins.…”

Section: Discussionmentioning

confidence: 95%

Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

Pesi¹,

Moraldi²,

Zambonin³

et al. 2014

JCT

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Background: Hepatocellular carcinoma (HCC) is one of the most common cancer in the world. Liver resection (LR) is the most used therapy in well compensated liver cirrhosis and maybe used as a first-line treatment. Aim of the study is to evaluate survival rates in patients who underwent LR for HCC and to identify risk factors able to influence the prognosis. Material/Method: A retrospective study was carried out in 115 patients who underwent LR for HCC. We evaluated overall and disease-free survival rates at 1, 3 and 5 years (y) and a series of variables included: type of resection, clamping, blood loss, transfusions, tumor size, presence of capsule, satellite nodules and vascular invasion. Results: The 1-, 3-, 5-y survival rates were 90.2%, 67% and 52.7%, and disease-free survival rates were 75.3%, 44.7% and 28.4%, respectively. We have found presence/ absence of capsulated tumor (p = 0.05), satellite nodules (p = 0.004) and vascular invasion (p = 0.001) as factors able to influence the overall survival and the disease-free survival (p = 0.04 for capsulated tumor, p = 0.01 for satellite nodules and p = 0.006 for vascular invasion). Conclusion: LR is the best therapeutic option for HCC when liver transplantation is contraindicated, with good survival rates. Presence of capsule, satellite nodules and vascular invasion are the most important factors able to influence the prognosis.

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Hepatic Resection for Hepatocellular Carcinoma in The Elderly

Cited by 108 publications

References 24 publications

The Survival Paradox of Elderly Patients After Major Liver Resections

The Survival Paradox of Elderly Patients After Major Liver Resections

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

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