JOURNAL OF SURGICAL ONCOLOGY 104, 3, 284 - 291 (2011).
Prognosis of Patients With Hepatocellular Carcinoma After Hepatic Resection: Are Elderly Patients Suitable for Surgery?
Atsushi Nanashima , Takafumi Abo , Takashi Nonaka , Hidetoshi Fukuoka , Shigekazu Hidaka , Hiroaki Takeshita , Tatsuki Ichikawa , Terumitsu Sawai , Toru Yasutake , Kazuhiko Nakao , Takeshi Nagayasu
Aim The indication for hepatectomy is still controversial in elderly patients with hepatocellular carcinoma (HCC). We examined the clinicopathological features and survival of 188 HCC patients who underwent hepatectomy. Patients/Methods Patients were divided into four age groups: Age<50 group (young patients <50 years of age, n = 9), Age50–69 group (between 50–69 years, n = 110), Age70–79 group (70–79 years, n = 57), and Age≥80 group (≥80 years, n = 12). Physiologic ability and surgical stress (E‐PASS) score, including preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were assessed. Results Proportion of patients of Age70–79 and Age≥80 groups increased significantly in the last 5 years (P < 0.01). Co‐morbidity, performance status, and American Society of Anesthesiologists score significantly increased with age (P < 0.05). Proportions of patients with irregular findings and necro‐inflammatory activity were significantly lower in Age70–79 and Age≥80 groups than in other groups (P < 0.05). Systemic postoperative complications were high in Age70–79 and Age≥80 groups. PRS increased significantly with age (P < 0.05). Multivariate analysis identified PRS ≥0.32 and age ≥70 years as significant determinants of systemic complications (P < 0.05). There were no significant differences in postoperative survivals among the groups. Conclusions Careful follow‐up and proper decision on hepatectomy upon assessment of PRS are important in elderly HCC patients. J. Surg. Oncol. 2011; 104:284–291. © 2011 Wiley‐Liss, Inc.