Hepatic resection for hepatocellular carcinoma in the elderly

Kaibori, Masaki; Matsui, Kosuke; Ishizaki, Morihiko; Saito, Takamichi; Kitade, Hiroaki; Matsui, Yoshihiko; Kwon, A‐Hon

doi:10.1002/jso.21221

Cited by 75 publications

(79 citation statements)

References 44 publications

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“…Highvolume hospitals seem to be characterized by lesser morbidity and in-hospital mortality [55] . performed in the last 15 years indeed documented encouraging results [25,26,[34][35][36][37][38][39]42,[47][48][49][50] (Table 1). …”

Section: Resectionmentioning

confidence: 93%

“…With respect to the gross pathology of HCC at presentation, several studies reported that in elderly patients HCC is more frequently mono-pauci focal and it is frequently associated with less advanced fibrosis. It is well-known that multifocal liver carcinogenesis is associated with the degree of liver fibrosis while, with ageing, carcinogenesis has much more time to progress even in the absence of relevant inflammation and fibrosis [26,[34][35][36][37][38][39][40][41][42][47][48][49][50][51][52] . It has been reported that HCC in elderly patients was more frequently encapsulated [35] .…”

Section: Epidemiologic Considerationsmentioning

confidence: 99%

“…Post-operative mortality in elderly patients was reported to range from 0 to 3.2% [25,[34][35][36][37][38][39][40][41][42][48][49][50][55][56][57] . In two retrospective studies from Far East, surgeryrelated in-hospital morbidity and mortality were not significantly different in older as compared to younger patient [26,50] . A surprisingly high mortality (10.5%) was found in aged (> 70 years) resected patients which, however, was not so different from that observed in younger patients (7.7%).…”

Section: Resectionmentioning

confidence: 99%

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Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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recommendation. We carried out a literature search in MEDLINE database for studies reporting on epidemiology, clinical characteristics and treatment outcome of HCC in elderly patients. Available data seem to indicate that in elderly patients the outcome of HCC is mostly influenced by liver function and tumor stage rather than by age and the latter should not influence treatment allocation. Age is not a risk for resection and older patients with resectable HCC and good liver function could gain benefit from surgery. Mild comorbidities do not seem a contraindication for surgery in aged patients. Conversely, major resection in elderly, even when performed in experienced high-volume centres, should be avoided. Both percutaneous ablation and transarterial chemoembolization are not contraindicated in aged patients and safety profile of these procedures is acceptable. Sorafenib is a viable option for advanced HCC in elderly provided that a careful evaluation of concomitant comorbidities, particularly cardiovascular ones, is taken into account. Available data seem to suggest that in either elderly and younger, treatment is a main predictor of outcome. Consequently, a nihilistic attitude of physicians towards under-or no-treatment of aged patients should not be longer justified. Core tip: The number of elderly patients with cancer is expected to rise in the next future, and facing with elderly cirrhotic patients with hepatocellular carcinoma (HCC) will characterize liver oncology scenario in the near future. International guidelines do not specifically address how to approach HCC in aged patients and no recommendations are available on age threshold to which clinical decisions should refer. Available data seem to rule out an intrinsic negative impact of age itself on HCC prognosis, and treatment allocation should be decided mainly according to HCC stage, liver residual function and general conditions. Indeed, a nihilistic AbstractMean age of hepatocellular carcinoma (HCC) patients has been progressively increasing over the last decades and ageing of these patients is becoming a real challenge in every day clinical practice. Unfortunately, international guidelines on HCC management do not address this problem exhaustively and do not provide any specific REVIEWSubmit a

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Section: Resectionmentioning

confidence: 93%

Section: Epidemiologic Considerationsmentioning

confidence: 99%

Section: Resectionmentioning

confidence: 99%

See 1 more Smart Citation

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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“…In particular, a few reports have found that it is now possible to perform hepatectomies safely even in elderly patients who have various complications [20][21][22]. However, there have only been a few studies of perioperative liver regeneration in elderly patients who undergo hepatectomies [23].…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome and Hepatic Regeneration after Hepatic Resection for Hepatocellular Carcinoma in Elderly Patients

et al. 2018

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Introduction: The rising proportion of elderly patients (aged 80 yearsor above) in our population means that more elderly patients are undergoing hepatectomy. Methods: Five-hundred and thirty patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were retrospectively analyzed with respect to their preoperative status and perioperative results, including remnant liver regeneration. The remnant liver volume was postoperatively measured with multidetector CT on postoperative day 7 and 1, 2, 5, and 12 months after surgery. An elderly group (aged 80 or older) was compared with a non-elderly group (aged less than 80 years). Results: Underlying diseases of the cardiovascular system were significantly more common in the elderly group (57.8%, p = 0.0008). The postoperative incidence of Clavien-Dindo Grade IIIa or higher complications was 20.0% in the elderly group and 24.3% in the non-elderly group, and this difference was not significant. As for regeneration of the remnant liver after resection, this was not morphologically delayed compared to the non-elderly group. Conclusions: In this study, we have demonstrated that safe, radical hepatectomy, similar to procedures performed on non-elderly patients, can be performed on patients with HCC aged 80 and older with sufficient perioperative care.

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“…The Child-Pugh clinical classification is used to determine the prognosis of chronic liver disease, mainly cirrhosis [2]. Slow hepatic clearance of indocyanine green (ICG) is associated with increased surgical risk and poor long-term outcomes [3]. 99m Tc-galactosyl human serum albumin is a well-established functional imaging technique for visual and quantitative analysis of radiopharmaceutical tracer uptake in the liver [4].…”

Section: Introductionmentioning

confidence: 99%

Optimizing signal intensity correction during evaluation of hepatic parenchymal enhancement on gadoxetate disodium-enhanced MRI: Comparison of three methods

Onoda

Hyodo

Murakami

et al. 2015

European Journal of Radiology

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a b s t r a c tObjective: To compare signal intensity (SI) correction using scale and rescale slopes with SI correction using SIs of spleen and muscle for quantifying multiphase hepatic contrast enhancement with Gd-EOB-DTPA by assessing their correlation with T 1 values generated from Look-Locker turbo-field-echo (LL-TFE) sequence data (ER-T 1 ). Materials and methods: Thirty patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in this prospective clinical study. For each patient, breath-hold T 1 -weighted fat-suppressed three-dimensional (3D) gradient echo sequences (e-THRIVE) were acquired before and 2 (first phase), 10 (second phase), and 20 min (third phase) after intravenous Gd-EOB-DTPA. Look-Locker turbo-fieldecho (LL-TFE) sequences were acquired before and 1.5 (first phase), 8 (second phase), and 18 min (third phase) postcontrast. The liver parenchyma enhancement ratios (ER) of each phase were calculated using the SI from e-THRIVE sequences (ER-SI) and the T 1 values generated from LL-TFE sequence data (ER-T 1 ) respectively. ER-SIs were calculated in three ways: (1) comparing with splenic SI (ER-SI-s), (2) comparing with muscle SI (ER-SI-m), (3) using scale and rescale slopes obtained from DICOM headers (ER-SI-c), to eliminate the effects of receiver gain and scaling. For each of the first, second and third phases, correlation and agreement were assessed between each ER-SI and ER-T 1 . Results: In the first phase, all ER-SIs correlated weakly with ER-T 1 . In the second and third phases, ER-SI-c showed a stronger linear correlation with ER-T 1 (r 2 = 0.71-0.72, p < 0.01) than did ER-SI-s (r 2 = 0.37-0.39, p < 0.01) or ER-SI-m (r 2 = 0.30-0.41, p < 0.01). Conclusion: SI correction using scale and rescale slopes from DICOM data is the most acceptable algorithm for evaluating delayed-phase Gd-EOB-DTPA hepatic enhancement.

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Hepatic resection for hepatocellular carcinoma in the elderly

Cited by 75 publications

References 44 publications

Management of hepatocellular carcinoma in the elderly

Management of hepatocellular carcinoma in the elderly

Surgical Outcome and Hepatic Regeneration after Hepatic Resection for Hepatocellular Carcinoma in Elderly Patients

Optimizing signal intensity correction during evaluation of hepatic parenchymal enhancement on gadoxetate disodium-enhanced MRI: Comparison of three methods

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