Liver resection in elderly patients over the age of 70 with primary liver cancer: A retrospective analysis.

Abstract

e15647 Background: Liver surgery in the elderly remains controversial amidst growing incidence in developed countries. This study compares perioperative outcomes of elderly with non-elderly patients undergoing curative hepatectomy for primary liver malignancies. Methods: 310 patients underwent liver resection for primary tumours between 2000 and 2018. There were 71 elderly (≥70 years) and 239 non-elderly patients ( < 70 years). Survival analyses, stratified according to pathology (Hepatocellular carcinoma (HCC), n = 262 and Cholangiocarcinoma (CC) n = 48), were compared between the elderly and non-elderly group. Multiple regression analyses were performed to evaluate independent predictors of major complications and overall survival. Results: Elderly patients had higher frailty score (modified Frailty Index, mean, 1.14 v 0.51, p < 0.001), more comorbidities (Comorbidities ≥4: 28% v 14%, p = 0.005), had non viral-induced primary liver cancers (Non-Hep B Non-Hep C: 65% v 19%, p < 0.001) with lower AST (p = 0.014) and ALT (p = 0.004) levels. 46% of patients underwent major hepatectomy and were similar between both groups (p = 0.502). The overall complication rate and duration of stay were comparable (p > 0.05). Post-Hepatectomy Liver Failure occurred in 10 (3%) patients with no difference between both groups (p > 0.05). There were 11 (4%) postoperative deaths with higher mortality in the elderly group (8% v 2%, p = 0.011). Multiple logistic regression revealed that MELD ≥11 (OR 2.415, p = 0.480) and a positive surgical margin (OR 2.549, p = 0.024) were independent predictors for major complications. The overall survival (OS) and disease free survival (DFS) for both HCC and CC were similar between elderly and non-elderly group respectively (HCC: 5-yr OS, 62% v 68.5%, p = 0.712; 5-yr DFS, 30.4% v 38.8%, p = 0.323; CC: 5-yr OS, 62.2% v 48.3%, p = 0.919; 5-yr DFS, 43.6% v 28.2%, p = 0.618). Multiple Cox regression revealed that albumin < 40g/L (HR 2.533, p = 0.002) and the presence of vascular invasion (HR 2.417, p = 0.004) were independent predictors of poor survival. Conclusions: Long-term survivals were comparable between the elderly and non-elderly patients following surgical treatment for primary liver cancers. Low albumin and vascular invasion predicted poor survival. Age alone should not be a contraindication to liver surgery. Major complications may be minimised by carefully selecting patient and paying particular attention to the MELD score in elderly patients with primary liver disease. Further prospective studies are required to confirm the findings here.