Publication:

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

Background Aging hinders the liver capacity to restitute its volume and function after partial hepatectomy. Concomitant hepatic parenchyma disorders and major resections may increase the susceptibility of elderly patients to worse postoperative outcome.

Methods Prospectively collected medical records of adult patients who underwent elective partial hepatectomy for malignant liver tumors at Sohag University Hospital (June 2014–May 2020) were analyzed. A group of elderly (≥65 years) were compared with a matched control group of non-elderly (<65 years) patients as regards posthepatectomy liver failure (PHLF) and overall complications, including mortality. Markers associated with PHLF and postoperative death were investigated.

Results Forty-eight patients were enrolled, 24 per group. 34 were males (71%). All patients had primary hepatic malignancy or metastatic tumors. Hepatocellular carcinoma (HCC) was the most common indication for liver resection in both groups (32 patients, 66.6%). Elderly patients exhibited significantly higher grades of overall postoperative complications (p<0.05). PHLF was significantly increased in the elderly group, in evident connection with significant persistence of higher bilirubin levels and reduced prothrombin concentration (p<0.05) until 5th postoperative day. Subgroup analysis showed that major resections and cirrhosis correlated with increased morbidity among elderly compared with younger patients. Postoperative mortality occurred in 3 elderly cirrhotic patients, who failed to recover normal platelet count postoperatively.

Conclusions In elderly patients, major liver resection for malignant tumors is associated with worse outcome, particularly in those with coexisting cirrhosis. Predictors include early postoperative thrombocytopenia and persistent hyperbilirubinemia and coagulopathy.