Major Liver Resection in Elderly Patients: A Multi-Institutional Analysis

Reddy, Srinevas K.; Barbas, Andrew S.; Turley, Ryan S.; Gamblin, T. Clark; Geller, David A.; Marsh, J. Wallis; Tsung, Allan; Clary, Bryan M.; Lagoo‐Deenadayalan, Sandhya

doi:10.1016/j.jamcollsurg.2010.12.048

Cited by 99 publications

(87 citation statements)

References 42 publications

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“…Portolani et al [56] , in a multivariate analysis on 175 elderly patients undergoing surgery, showed that major resection was an adverse predictor of overall survival (OS). Similar results were reported by Reddy et al [40] who found that increasing age (> 60 years) was independently associated with postoperative mortality after major hepatic resection even when performed in experienced, high-volume centres. The authors concluded that major resection in elderly patients should be avoided or limited to selected cases and possibly performed by experienced.…”

Section: Resectionsupporting

confidence: 89%

“…In many studies, elderly patients with HCC were more likely to be hepatitis C virus (HCV) carriers [30][31][32][33][34][35][36][37][38][39][40][41][42][43] . In fact, unlike HBV infection, most HCV infections are acquired late in life and HCV-related carcinogenesis needs a long-time interval to accomplish.…”

Section: Epidemiologic Considerationsmentioning

confidence: 99%

“…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%

“…Data on survival and disease free survival in old and young patients undergoing HCC resection are reported in Table 1. 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] .…”

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: Resectionsupporting

confidence: 89%

Section: Epidemiologic Considerationsmentioning

confidence: 99%

Section: Epidemiologic Considerationsmentioning

confidence: 99%

Section: Resectionmentioning

confidence: 99%

See 2 more Smart Citations

Management of hepatocellular carcinoma in the elderly

Borzio

Dionigi

Parisi

et al. 2015

WJH

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show abstract

“…Most western data however, points towards increasing mortality and morbidity trends in the elderly who undergo major hepatic resections [29] . An ACS-NSQIP review of 7,621 hepatectomies between 2005 and 2010, including 894 patients ≥ 75 years, has reported worse outcomes in the elderly population in spite of them undergoing lesser procedures: mortality 4.8 vs. 2%, and morbidity 23.9 vs. 18.4% [30] .…”

Section: Discussionmentioning

confidence: 99%

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Batra¹,

Suradkar²,

Talole

et al. 2016

Dig Surg

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Background: There are no data on surgical outcomes of major gastrointestinal cancer resections in the expanding Indian oncogeriatric population. Methods: A prospective database of patients who underwent major gastrointestinal cancer resections during varying time periods (2006-2014) was analyzed retrospectively. Results: Two thousand six hundred and forty three patients with a median age of 53 were analyzed. Four hundred and seventy two (17.9%) patients were aged ≥65 years and 235 (8.9%) patients were ≥70 years. Mortality rates were not significantly higher in the elderly (≥65 years) or the very elderly (≥70 years) when compared to younger controls, being 2.8 vs. 1.6% (p = 0.09) and 3.0 vs. 1.7% (p = 0.162) respectively. Overall morbidity was similar for patients ≥65 or <65 years (24.2 vs. 21.7%, p = 0.253), but was higher in patients ≥70 years (29.8 vs. 21.4%, p = 0.003). The incidence of severe complications, however, was not significantly greater in this age group (13.2 vs. 12.5%, p = 0.74). Conclusions: Major gastrointestinal cancer resections in the elderly Indian population, though uncommon, are safe when performed at experienced high volume centres. These results should serve as a starting point for the gradual development of dedicated oncogeriatric programs in the Indian subcontinent.

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Effect of LSKL peptide on thrombospondin 1-mediated transforming growth factor β signal activation and liver regeneration after hepatectomy in an experimental model

Kuroki

Hayashi

Nakagawa

et al. 2015

British Journal of Surgery

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BackgroundA strategy for accelerating liver regeneration after hepatectomy would offer great benefits in preventing postoperative liver failure and improving surgical outcomes. Transforming growth factor (TGF) β is a potent inhibitor of hepatocyte proliferation. Recently, thrombospondin (TSP) 1 has been identified as a negative regulator of liver regeneration by activation of local TGF-β signals. This study aimed to clarify whether the LSKL (leucine–serine–lysine–leucine) peptide, which inhibits TSP-1-mediated TGF-β activation, promotes liver regeneration after hepatectomy in mice.MethodsMice were operated on with a 70 per cent hepatectomy or sham procedure. Operated mice received either LSKL peptide or normal saline intraperitoneally at abdominal closure and 6 h after hepatectomy. Perioperative plasma TSP-1 levels were measured by enzyme-linked immunosorbent assay in patients undergoing hepatectomy.ResultsAdministration of LSKL peptide attenuated Smad2 phosphorylation at 6 h. S-phase entry of hepatocytes was accelerated at 24 and 48 h by LSKL peptide, which resulted in faster recovery of the residual liver and bodyweight. Haematoxylin and eosin tissue staining and blood biochemical examinations revealed no significant adverse effects following the two LSKL peptide administrations. In the clinical setting, plasma TSP-1 levels were lowest on the first day after hepatectomy. However, plasma TSP-1 levels at this stage were significantly higher in patients with subsequent liver dysfunction compared with levels in those without liver dysfunction following hepatectomy.ConclusionOnly two doses of LSKL peptide during the early period after hepatectomy can promote liver regeneration. The transient inhibition of TSP-1/TGF-β signal activation using LSKL peptide soon after hepatectomy may be a promising strategy to promote subsequent liver regeneration.

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Major Liver Resection in Elderly Patients: A Multi-Institutional Analysis

Cited by 99 publications

References 42 publications

Management of hepatocellular carcinoma in the elderly

Management of hepatocellular carcinoma in the elderly

Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Effect of LSKL peptide on thrombospondin 1-mediated transforming growth factor β signal activation and liver regeneration after hepatectomy in an experimental model

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