Safety and oncological benefits of hepatectomy for hepatocellular carcinoma in octogenarians

Hayashi, Hikaru; Shimizu, Akira; Motoyama, Hiroaki; Koyama, Koji; Noguchi, Tsuyoshi; Masuo, Hitoshi; Yoshizawa, Takahiro; Hosoda, Kiyotaka; Sakai, Hiroki; Yasukawa, Koya; Soejima, Yuji

doi:10.1016/j.asjsur.2022.04.074

Cited by 1 publication

(2 citation statements)

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“…Most reports indicate that liver resection can be safely performed in elderly patients, which is considered a result of adequate preoperative risk assessment. [18][19][20][21] However, the risk of major postoperative complications in octogenarian liver resection is associated with men and the duration of hepatic pedicle occlusion. 22 In this study, age was significantly associated with surgical mortality in patients who underwent hepatic resection with vascular reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports on the outcomes of liver resection in elderly patients have been published through nationwide surveys, multi‐institutional, and single‐center studies. Most reports indicate that liver resection can be safely performed in elderly patients, which is considered a result of adequate preoperative risk assessment 18–21 . However, the risk of major postoperative complications in octogenarian liver resection is associated with men and the duration of hepatic pedicle occlusion 22 …”

Section: Discussionmentioning

confidence: 99%

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Short‐term outcomes after liver resection with vascular reconstruction: Results from a study with the National Clinical Database of Japan

Soyama,

Yamamoto,

Eguchi

et al. 2024

J Hepato Biliary Pancreat

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BackgroundAlthough curative resection with vascular reconstruction improves the prognosis of blood‐invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction.MethodsThis retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated.ResultsAmong the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction.ConclusionsThe NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.

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