Liver Resection versus Ablation in Geriatric Populations – Does One Method Impart Improved In-Hospital Mortality

Abstract

Introduction: There is a wide variety of therapeutic options to treat liver malignancies, however there is a paucity of data on how best to treat geriatric patients. This study was conducted to compare outcomes of the most commonly used surgical methods for liver malignancies(resection versus ablation) in patients aged 65 and older. Methods: The ACS NSQIP database was queried for patients ≥65 years old who underwent liver resection or ablation for liver malignancy. Univariate log-rank test and multivariate Cox proportional hazards regression are used for time-to-event analysis. Match propensity analysis was performed. Logistic regression models for 30-day morbidity and mortality for liver resection and ablation are also constructed. Results: 7075 patients underwent surgical treatment for liver malignancy: 6,378(90%) liver resection and 697(10%) liver ablation. Median age was 72 years in both groups(p=0.41). Patients had a higher BMI in the ablation group(28.3±5.4 vs. 27.8±5.6, p=0.027). Preoperative laboratory data demonstrate more severe liver disease in patients undergoing ablation(Table 1). Matched analysis demonstrates that patients with liver resection were more likely to develop an abdominal abscess(OR: 4.34, p<0.001), require reintubation(OR:1.68, p=0.031), have bleeding(OR: 4.08, p<0.001), or sepsis(OR: 3.14 p<0.001) postoperatively. In-hospital mortality was significantly higher in patients treated with liver resection(1.82; CI 1.067 – 3.101; p=0.022). Resection portended a worse survival in primary liver tumors (Figure 1). Conclusion: Patients undergoing liver ablation were sicker, with worse underlying liver function, yet had lower in-hospital mortality. For primary malignancies, resection had a significantly worse 30-day survival.Tabled 1Preoperative LabsResectionAblationp-valueBilirubin0.74 ± 0.850.86 ± 0.64p=0.009AST37 ± 3941 ± 32p=0.003Alkaline Phosphatase114 ± 88108 ± 57p=0.016Albumin3.9 ± 0.53.7 ± 0.6p<0.001Platelets218 ± 84163 ± 74p<0.001INR1.05 ± 0.181.12 ± 0.22p<0.001Sodium139.2 ± 3.1138.8 ± 3.2p=0.008Cr0.98 ± 0.481.0 ± 0.56p=0.39 Open table in a new tab