aDepartment of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine bInstitute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an cDepartment of General Surgery, Bazhong Central Hospital, Bazhong, People's Republic of China.
Eur J Gastroenterol Hepatol. 2014 Apr;26(4):444-51. doi: 10.1097/MEG.0000000000000046.
Because of an increasing aging population worldwide, a greater number of elderly patients are being considered for hepatic resection. The objective of this retrospective pair-matched study was to assess the influence of age on postoperative outcomes after major hepatectomy (resection of three or more Couinaud segments) in elderly patients with hepatocellular carcinoma (HCC) and cirrhosis.
A retrospective review of patient demographics, diagnoses, surgical treatments, and early postoperative outcomes was performed.
A total of 208 HCC patients with cirrhosis underwent major hepatectomy between 2007 and 2012. The mortality rate was 3.57% in patients aged 70 years or more (group E) compared with 1.32% in those aged below 70 years (group Y; P=0.630). The overall complication rates were 53.57% in group E and 47.37% in group Y (P=0.427). Increasing age was independently associated with postoperative pneumonia (P<0.001), bacteremia (P=0.026), and respiratory failure requiring reintubation (P=0.028). A total of 25.00% of patients had a Clavien-Dindo classification grade of 3a or more in group E compared with 13.16% in group Y (P=0.040). In multivariate analysis, intraoperative red blood cell transfusion of 5 U or more (P=0.016; hazard ratio 4.812; 95% confidence interval 1.332-17.384) was a predictor of higher morbidity in the elderly.
With rigorous screening of patients and improvement of perioperative management and operative techniques, major hepatectomy can be safely performed on HCC patients aged 70 years or more with liver cirrhosis. Intraoperative red blood cell transfusion of 5 U or more was predictive of higher morbidity in the elderly. Surgeons should take care to minimize the likelihood of intraoperative blood transfusion in elderly patients.
由于全球人口老龄化的增加，越来越多的老年患者被考虑进行肝切除术。本回顾性配对研究的目的是评估年龄对伴有肝硬化的肝细胞癌（HCC）老年患者行大范围肝切除（切除三个或更多 Couinaud 段）术后结局的影响。
对患者的人口统计学、诊断、手术治疗和术后早期结局进行回顾性分析。
2007 年至 2012 年间，共有 208 例伴有肝硬化的 HCC 患者行大范围肝切除术。70 岁及以上（E 组）患者的死亡率为 3.57%，而 70 岁以下（Y 组）患者的死亡率为 1.32%（P=0.630）。E 组的总并发症发生率为 53.57%，Y 组的总并发症发生率为 47.37%（P=0.427）。高龄与术后肺炎（P<0.001）、菌血症（P=0.026）和需要重新插管的呼吸衰竭（P=0.028）独立相关。E 组有 25.00%的患者 Clavien-Dindo 分级为 3a 级或更高级别，而 Y 组的这一比例为 13.16%（P=0.040）。多变量分析显示，术中输注红细胞 5U 或以上（P=0.016；危险比 4.812；95%置信区间 1.332-17.384）是老年患者发病率较高的预测因素。
通过严格筛选患者，改善围手术期管理和手术技术，可安全为年龄 70 岁及以上伴有肝硬化的 HCC 患者施行大范围肝切除术。术中输注红细胞 5U 或以上可预测老年患者发病率较高。外科医生应注意尽量减少老年患者术中输血的可能性。
