Department of Visceral Surgery, University Hospital Lausanne (CHUV), Bugnon 46, 1012 Lausanne, Switzerland.
World J Surg. 2012 Sep;36(9):2161-70. doi: 10.1007/s00268-012-1621-1.
As a consequence of the increase in life expectancy, hepatobiliary surgeons have to deal with an emerging aged population. We aimed to analyze the liver function and outcome after right hepatectomy (RH) in patients over 70 years of age.
From January 2006 to December 2009, we prospectively collected data of 207 consecutive elective hepatectomies. In patients who had RH, cardiac risk was assessed by a dedicated preoperative workup. Liver failure (LF) was defined by the "fifty-fifty" criteria at postoperative day 5 (POD) and morbidity by the Clavien-Dindo classification. Liver function tests (LFTs) and short-term outcome were retrospectively analyzed in patients over (elderly group, EG) and younger (young group, YG) than 70 years of age.
Eighty-seven consecutive RH were performed during the study period. Indication for surgery included 90 % malignancy in 47 % of patients requiring preoperative chemotherapy. ASA grade > 2 (44 vs. 16 %, p = 0.027), ischemic heart disease (17 vs. 5 %, p = 0.076), and preoperative cardiac failure (26 vs. 2 %, p < 0.001) were more frequent in the EG (n = 23) than in the YG (n = 64). Both groups were similar regarding rates of normal liver parenchyma, chemotherapy and intraoperative parameters. The overall morbidity rates were comparable, but the serious complication (grades III-V) rate was relatively higher in the EG (39 vs. 25 %, p = 0.199), particularly in patients with diabetes mellitus (100 vs. 29 %, p = 0.04) and those who had additional nonhepatic surgery (67 vs. 35 %, p = 0.110) and transfusions (44 vs. 30 %, p = 0.523). The 90-day mortality rate was similar (9 % in the EG vs. 3 % in the YG, p = 0.28) and was related to heart failure in the EG. LFTs showed a similar trend from POD 1 to 8, and patients ≥70 years of age had no liver failure.
Age ≥70 years alone is not a contraindication to RH. However, major morbidity is particularly higher in the elderly with diabetes. This high-risk group should be closely monitored in the postoperative course. Liver function is not altered in the elderly patient after RH.
随着预期寿命的延长，肝胆外科医生必须应对不断增加的老年人口。我们旨在分析 70 岁以上患者右肝切除术（RH）后的肝功能和结果。
从 2006 年 1 月至 2009 年 12 月，我们前瞻性地收集了 207 例连续择期肝切除术患者的数据。对于接受 RH 的患者，通过专门的术前检查评估心脏风险。术后第 5 天（POD）采用“五十对五十”标准定义肝功能衰竭（LF），采用 Clavien-Dindo 分类定义发病率。回顾性分析年龄大于（老年组，EG）和小于（年轻组，YG）70 岁的患者的肝功能检查（LFTs）和短期结果。
研究期间进行了 87 例连续 RH。手术适应证包括 90%的患者为恶性肿瘤，其中 47%的患者需要术前化疗。ASA 分级>2（44%比 16%，p=0.027）、缺血性心脏病（17%比 5%，p=0.076）和术前心力衰竭（26%比 2%，p<0.001）在 EG（n=23）中更为常见，而在 YG（n=64）中则不常见。两组正常肝实质、化疗和术中参数的比例相似。总体发病率相似，但 EG（39%比 25%，p=0.199），特别是糖尿病（100%比 29%，p=0.04）和其他非肝脏手术（67%比 35%，p=0.110）和输血（44%比 30%，p=0.523）患者的严重并发症（III-V 级）发生率相对较高。90 天死亡率相似（EG 为 9%，YG 为 3%，p=0.28），与 EG 中的心力衰竭有关。LFTs 在 POD 1 至 8 期间呈相似趋势，70 岁以上的患者无肝功能衰竭。
年龄≥70 岁本身并不是 RH 的禁忌症。然而，糖尿病老年患者的主要发病率特别高。这一高危人群应在术后密切监测。老年患者 RH 后肝功能无改变。
