LIVER RESECTIONS IN ELDERLY PATIENTS
Sotiropoulos GC, Kostakis ID, Machairas N, Tsaparas P, Stamopoulos P,
Dimitroulis D, Kouraklis G
2nd Department of Propedeutic Surgery, University of Athens Medical School, Athens, Greece
• Introduction: Surgeons are often reluctant to perform
major operations on elderly patients due to frequent
coexistent
comorbidities
that
increase
the
intraoperative risk. Herein, we report our experience in
performing liver resections in elderly patients.
• Patients and methods: One hundred thirteen
patients have undergone liver resection by two
surgeons in the course of 52 months. We reviewed
our database, recorded and analyzed the patients’
demographics, tumor characteristics, type of operation
and overall and disease-free survival in patients aged
75 years or older.
• Results: Fourteen out of the 113 patients were 75
years or older. Data about patients’ demographics and
tumor characteristics are listed in Table 1. Data
concerning the types of liver resections are shown in
Table 2. No in-hospital death was noted. Three
patients were admitted to intensive care unit
postoperatively. Mean hospital stay was 9.1 days
(range: 6-23 days). Two patients with hepatocellular
carcinoma presented with recurrent disease 12 and
18 months after the operation, respectively, and
another with intrahepatic cholangiocarcinoma 12
months after the operation. Moreover, 3 other
patients, 1 with hepatocellular carcinoma, 1 with
intrahepatic cholangiocarcinoma and 1 with colorectal
metastases, died of other causes 6, 16 and 24 months
Table 1. Patients’ demographics and tumor
characteristics
Gender
Age (mean (range))
HBV Ag (+)
HCV Ab (+)
Cirrhosis
Hepatocellular carcinoma
after the operation, respectively, and 1 with
hepatocellular carcinoma died due to disease
recurrence 24 months after the operation.
• Conclusions: Liver resections, even major, can be
feasible and safe in elderly patients, on the condition
that their performance status is good enough and they
do not have major comorbidities. The careful selection
of patients as candidates for liver resections can lead
to favorable long-term results.
Table 2. Types of liver resections
Right hepatectomy
1/14
Left hepatectomy
3/14
Segmentectomy
9/14 (2 combined with right
hemicolectomy)
Left lateral hepatectomy and 1/14
segmentectomy
a
b
11 men, 3 women
79 years (75-89)
3/14
0/14
1/14
7/14 (3 pT1, 1 pT2,
2 pT3a, 1 pT3b)
Intrahepatic cholangiocarcinoma 3/14 (2 pT1, 1 pT2b)
Colorectal metastases
4/14
Maximum tumor diameter
(range)
2.3cm – 13cm
Figure 1: Image of left hepatectomy (Seg I-IV) with additional
resection of extrahepatic biliary tree, cholecystectomy and lymph node
dissection for hilar cholangiocarcinoma in an 83 year old patient (a),
image of left hepatectomy (Seg I-III) for a large symptomatic HCC in
an 89 year old patient (b).