The Survival Paradox of Elderly Patients After Major Liver Resections

• Published in: Journal of gastrointestinal surgery Vol. 12; no. 12; pp. 2196 - 2203
• Main Authors: IJtsma, Alexander J. C., Boevé, Liselotte M. S., van der Hilst, Christian S., de Boer, Marieke T., de Jong, Koert P., Peeters, Paul M. J. G., Gouw, Annet S. H., Porte, Robert J., Slooff, Maarten J. H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.12.2008; Springer Nature B.V
• Subjects: Age; Aged; Aged, 80 and over; Case-Control Studies; Gastroenterology; Heart attacks; Hepatectomy; Hospital Mortality; Humans; Liver; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Prognosis; Proportional Hazards Models; Prospective Studies; Surgery; Survival Rate; Treatment Outcome; Case-control studies; Aged; Survival; Liver; Surgery
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-008-0563-2

Objective The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. Patients and Methods From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Results Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p  = 0.017 and 47% versus 31%, p  = 0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients ( p  = 0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. Conclusion This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age.