Ferrero Alessandro, Viganò Luca, Polastri Roberto, Ribero Dario, Lo Tesoriere Roberto, Muratore Andrea, Capussotti Lorenzo
Department of Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Turin, Italy.
World J Surg. 2005 Sep;29(9):1101-5. doi: 10.1007/s00268-005-7768-2.
In recent decades liver resection has become a safe procedure; however, the outcome of hepatectomies in aged cirrhotic patients is often uncertain. To elucidate early and long-term outcomes of hepatectomy for HCC in the elderly, we studied 241 cirrhotic patients who underwent liver resection for HCC between 1985 and 2003. According to their age at the time of surgery, patients were divided into two groups: aged > 70 years (64 patients) and aged < or = 70 years (177 patients). Operative mortality was 3.1% in the elderly and 9.6% in the younger group (p = 0.113). Postoperative morbidity and liver failure rates were higher in the younger group (42.4% versus 23.4%, p = 0.0073; 12.9% versus l.6%, p = 0.0065). Five-year survival rates are 48.6% in the elderly group and 32.3% in the younger group (p = 0.081). Considering only radical resections in Child-Pugh A patients, survival remains similar in the two groups (p = 0.072). Disease-free survival is not different in the two groups. A survival analysis performed according to the tumor diameter shows a better survival for elderly Child-Pugh A patients with HCC larger than 5 cm radically resected (50.8% versus 16.1% 5-year survival, p = 0.034). In univariate analysis, tumor size is not a prognostic factor in the elderly, whereas younger patients with large tumors have a worse outcome. Age by itself is not a contraindication for surgery, and selected cirrhotic patients with HCC who are 70 years of age or older could benefit from resection, even in the presence of large tumors. Long-term results of liver resections for HCC in the elderly may be even better than in younger patients.
近几十年来，肝切除术已成为一种安全的手术；然而，老年肝硬化患者肝切除的结果往往不确定。为了阐明老年肝癌患者肝切除的早期和长期结果，我们研究了1985年至2003年间接受肝癌肝切除的241例肝硬化患者。根据手术时的年龄，患者分为两组：年龄>70岁（64例）和年龄≤70岁（177例）。老年组手术死亡率为3.1%，年轻组为9.6%（p = 0.113）。年轻组术后发病率和肝衰竭率更高（42.4%对23.4%，p = 0.0073；12.9%对1.6%，p = 0.0065）。老年组5年生存率为48.6%，年轻组为32.3%（p = 0.081）。仅考虑Child-Pugh A级患者的根治性切除，两组生存率相似（p = 0.072）。两组无病生存率无差异。根据肿瘤直径进行的生存分析显示，根治性切除的肿瘤大于5 cm的老年Child-Pugh A级肝癌患者生存率更高（5年生存率50.8%对16.1%，p = 0.034）。单因素分析中，肿瘤大小不是老年患者的预后因素，而肿瘤较大的年轻患者预后较差。年龄本身并非手术禁忌证，即使存在大肿瘤，选择的70岁及以上的肝硬化肝癌患者也可能从切除术中获益。老年肝癌患者肝切除的长期结果可能甚至优于年轻患者。
