Clinical Trials Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6620-6625
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6620
Liver resection in hepatitis B related-hepatocellular carcinoma: Clinical outcomes and safety in elderly patients
Hai-Qing Wang, Jian Yang, Lu-Nan Yan, Xiao-Wu Zhang, Jia-Yin Yang
Hai-Qing Wang, Jian Yang, Lu-Nan Yan, Xiao-Wu Zhang, Jia-Yin Yang, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: All authors contributed equally to this work and designed the research; Yang J, Yang JY and Zhang XW analyzed and interpreted the data; Wang HQ and Yan LN drafted the manuscript; all authors have read and approved the final manuscript.
Supported by Grants from the National Science and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002-017
Correspondence to: Jia-Yin Yang, PhD, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, Sichuan Province, China. yangjygyz@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: November 30, 2013
Revised: March 8, 2014
Accepted: March 19, 2014
Published online: June 7, 2014
Abstract

AIM: To compare the morbidity and mortality in young and elderly hepatocellular carcinoma (HCC) patients undergoing liver resection.

METHODS: We retrospectively enrolled 1543 consecutive hepatitis B (HBV)-related HCC patients undergoing elective hepatic resection in our cohort, including 207 elderly patients (≥ 65 years) and 1336 younger patients (＜ 65 years). Patient characteristics and clinical outcomes after liver resection were compared between the two groups.

RESULTS: Elderly patients had more preoperative comorbidities and lower alanine aminotransferase and aspartate aminotransferase levels. Positive rates for hepatitis B surface antigen (P ＜ 0.001), hepatitis B e antigen (P ＜ 0.001) and HBV DNA (P = 0.017) were more common in younger patients. Overall complications and their severity classified using the Clavien system were similar in the two groups (33.3% vs 29.6%, P = 0.271). Elderly patients had a higher rate of postoperative cardiovascular complications (3.9% vs 0.6%, P = 0.001), neurological complications (2.9% vs 0.4%, P ＜ 0.001) and mortality (3.4% vs 1.2%, P = 0.035), and had more hospital stay requirement (13 d vs 12 d , P < 0.001) and more intensive care unit stay (36.7% vs 27.8%, P = 0.008) compared with younger patients. However, postoperative hepatic insufficiency was more common in the younger group (7.7% vs 3.4%, P = 0.024).

CONCLUSION: Hepatectomy can be safely performed in elderly patients. Age should not be regarded as a contraindication to liver resection with expected higher complication and mortality rates.

Keywords: Elderly, Hepatocellular carcinoma, Hepatectomy, Complication, Hepatitis B

Core tip: Elderly patients are regarded as unsuitable for liver resection due to the presence of comorbidities. Our study found that elderly patients did have more comorbidities than younger patients, but also had better liver function and reduced hepatitis B infection. Elderly patients had similar overall morbidity and higher mortality compared with younger patients. Older patients also had more cardiovascular complications, neurological complications and a longer hospital stay, but less hepatic insufficiency. Our study suggested that liver resection can be safely performed in carefully selected elderly patients with accepted higher complication and mortality rates.