Age no bar for Elderly Patients undergoing Liver Resection for Hepatocellular Carcinoma, Study Finds

Egypt: Curative liver resection (LR) can be safely carried out in carefully selected elderly patients with hepatocellular carcinoma (HCC), a recent study published in BMC Surgery has shown. The researchers suggest that advanced age should not be used as an automatic disqualification for this potentially life-saving procedure.

Hepatocellular carcinoma, a common and aggressive liver cancer, poses significant treatment challenges, particularly for older patients. Traditionally, advanced age has often been seen as a contraindication for major surgical interventions like liver resection. Concerns about increased surgical risks and diminished recovery potential have led some clinicians to favor alternative treatments or palliative care for elderly patients with HCC.

Against the above background, Ahmed Shehta, Mansoura University, Mansoura, Egypt, and colleagues aimed to assess the impact of patient age on outcomes of liver resection for hepatocellular carcinoma.

For this purpose, the researchers analyzed hepatocellular carcinoma patients who underwent liver resection (LR) between 2010 and 2020. These patients were divided into three age groups: Group I (under 60 years), Group II (60 to 69 years), and Group III (70 years and older). Three hundred sixty-four patients were included.

The study led to the following findings:

• A significantly higher serum bilirubin and alpha fetoprotein were noted in Group I, and serum creatinine was noted in Group III.
• The study groups did not show significant differences regarding HCC site, number, macrovascular invasion, the extent of LR, Pringle maneuver, and perioperative blood transfusions.
• Longer operation time was found in Groups II and III, while more blood loss was noted in Group (I) Group I patients had longer hospital stays.
• Higher postoperative morbidities were noted in both Group I and Group (II) Higher incidence of post-hepatectomy liver dysfunction was noted in Group I.
• More early mortalities were found in Group I, related to liver failure.
• The researchers did not experience early mortality in Group (III) Late Mortalities occurred in 32.1% of patients.
• HCC recurrence occurred in 45.3% of patients.
• Regarding the overall- and tumor-free survival, there were no significant differences among the three groups.

In conclusion, select elderly patients with hepatocellular carcinoma can safely undergo curative liver resection. The study found that the perioperative, oncological, and survival outcomes for older patients were comparable to those of younger individuals.

"To achieve favorable results, it is crucial to conduct thorough preoperative evaluations, utilize appropriate surgical techniques, and provide diligent postoperative care. Age alone should not preclude elderly patients from receiving potentially life-saving liver surgery," the researchers wrote.

Reference:

Shehta, A., Medhat, M., Farouk, A. et al. Liver resection for hepatocellular carcinoma in elderly patients: does age matter?. BMC Surg 24, 248 (2024). https://doi.org/10.1186/s12893-024-02528-7