Outcomes after Major Hepatectomy in Elderly Patients

Menon, Krishna; Al-Mukhtar, Ahmed; Aldouri, Amer; Prasad, Rajendra; Lodge, Peter; Toogood, Giles J.

doi:10.1016/j.jamcollsurg.2006.07.025

Cited by 136 publications

(112 citation statements)

References 17 publications

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“…Type of tumor was divided in colorectal metastasis, hepatocellular carcinoma, or other malignant or benign tumors. In concordance with recent literature, 10 intraoperative blood transfusions were noted as less than three packed cells or three or more packed cells transfused peroperatively. Resection margin status was defined as R0 resection when all surgical margins were microscopically free of tumor cells, R1 resection when tumor cells were identified on light microscopy in one or more of the margins, and palliative resection when macroscopic tumor was left behind in one or more of the margins or outside the liver.…”

Section: Methodssupporting

confidence: 86%

“…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: Methodssupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Survival Paradox of Elderly Patients After Major Liver Resections

IJtsma

Boevé

Hilst

et al. 2008

Journal of Gastrointestinal Surgery

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“…Most studies define the ‘elderly' as patients >70 [27,28] or 75 [29], while others use 65 [30] or even 80 [31] years of age. When the elderly are compared with younger patients, practically all studies choose to include all patients above and under a certain age (e.g., comparing patients >75 with patients <75 years) [9,13,27,28,29,31]. Borderline elderly in studies conducted according to such definitions might well affect the clarity of the results and messages as slight differences in age may put patients in different cohorts.…”

Section: Discussionmentioning

confidence: 99%

Effect of Age on Liver Function in Patients Undergoing Partial Hepatectomy

Lodewick

Alizai

Dam³

et al. 2017

Dig Surg

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Background: Postresectional liver failure is the most frequent cause of fatal outcome following liver surgery. Diminished preoperative liver function in the elderly might contribute to this. Therefore, the aim of the present study was to evaluate preoperative liver function in patients <60 or >70 years of age scheduled for liver resection. Methods: All consecutive patients aged <60 or >70 years who are about to undergo elective liver surgery between 2011 and 2013 and underwent the methacetin breath liver function test (LiMAx) preoperatively were included. Histologic assessment of the resected liver gave insight into background liver disease. Correlation between age and liver function was calculated with Pearson's test. Results: Fifty-nine patients were included, 31 were aged <60 and 28 were aged >70 years. General patient characteristics and liver function LiMAx values (340 (137-594) vs. 349 (191-530) μg/kg/h, p = 0.699) were not significantly different between patients aged <60 and >70 years. Moreover, no correlation between age and preoperative liver function LiMAx values was found (R = 0.04, p = 0.810). Conclusion: Liver function did not seem to differ between younger and older patients.

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“…Several clinico-pathological features such as number of hepatic metastases, size of the largest hepatic metastases, distribution of hepatic tumors, extent of hepatic resection and status of resection margin [1,[12][13][14][15], have been identified as prognostic factors. Recent published literature has shown a correlation between the presence of systemic inflammation with poorer cancer-specific survival in patients with colorectal carcinoma [16,17], suggesting the host's systemic inflammatory response to tumor may play a significant role in determining ''aggressiveness'' of tumor biology and prognosis.…”

Section: Introductionmentioning

confidence: 99%