The Survival Paradox of Elderly Patients After Major Liver Resections

Abstract

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.

Time‐dependent impact of age and comorbidities on long‐term overall survival after liver resection

“…Following liver resection and other major abdominal surgery, the effect of age and comorbidities on morbidity and post-operative mortality has been extensively assessed with partially conflicting results (2,8,10,12,14,20,21,23,(45)(46)(47)(48). These discrepancies may be explained by differences in the population risk profiles, patient selection and aggressiveness of resection.…”

“…Ageing of the Western population and advances in perioperative care and surgical techniques have resulted in an increase in the number of elderly patients being scheduled for resection of primary and secondary liver tumours . In Europe, life expectancy at the age of 65 is projected to increase by 5.4 years for men and 5.2 years for women, ultimately reaching 21.8 and 25.1 years by 2060 respectively .…”

Functional hepatocellular regeneration in elderly patients undergoing hepatectomy

“…Furthermore, liver resection remains the only potentially curative treatment option for most types of malignant HPB tumours . Paradoxically, only 8–15% of patients undergoing liver resection are older than 70 years , a reality that can be explained by a progressive reduction in organic functional reserve and a higher prevalence of comorbidities among elderly patients, which confers them a higher surgical risk . However, several authors have shown that well‐selected elderly patients, suffering from primary or secondary hepatic lesions, have similar results and benefit from hepatic resection in the same way as younger patients .…”

Frailty and Liver resection: where do we stand?

“…Although most elderly patients were transferred to rehabilitation facilities postoperatively, there was no difference in terms of severe postoperative complications. The authors also performed a literature review and included 14 previous studies; only two (14.3%) [27,28] of them reported a statistically significant difference in severe postoperative complications and only two (14.3%) [28,29] reported a statistically significant difference in mortality between old and young patients. Additionally, a large single-center study from France showed that age ≥ 75 years is a risk factor of mortality after liver resection [30] , while a multicenter study from the US showed that increasing age is associated with increased postoperative sepsis and overall mortality, but not overall morbidity [31] .…”