Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
J Gastrointest Surg. 2014 Jun;18(6):1161-70. doi: 10.1007/s11605-014-2516-2. Epub 2014 Apr 9.
Liver resection is increasingly performed in elderly patients who are suspected of increased postoperative morbidity (PM) and reduced overall survival (OS). Patient selection based on the identification of age-adjusted risk factors may help to decrease PM and OS.
Prospectively collected data of 879 patients undergoing elective hepatic resection were analyzed. This population was stratified into three age cohorts: >70 years (n = 228; 26 %), 60-69 years (n = 309; 35 %), and <60 years (n = 342; 39 %). Multivariate survival analysis was performed.
The incidence of severe (p < 0.01) and non-surgical (p < 0.001) postoperative complications was higher in older compared to younger patients. Major estimated blood loss (EBL; p = 0.039) and comorbidities (p = 0.002) independently increased PM. EBL was comparable between all age cohorts. However, preexisting comorbidities, major EBL, and postoperative complications markedly decreased OS in contrast to younger patients. Adjusted for age, independent predictors of OS were comorbidities (HR = 1.51; p = 0.001), major hepatectomy (HR = 1.33; p = 0.025), increased EBL (HR = 1.32; p = 0.031), and postoperative complications (HR = 1.64; p < 0.001).
Although increased age should not be a contraindication for liver resection, this study accents the avoidance of major blood loss in elderly patients and a stringent patient selection based on preexisting comorbidities.
肝脏切除术在疑似术后发病率（PM）增加和总生存期（OS）降低的老年患者中越来越多地进行。基于识别年龄调整风险因素的患者选择可能有助于降低 PM 和 OS。
分析了 879 例接受择期肝切除术的患者的前瞻性收集数据。该人群分为三个年龄组：>70 岁（n = 228；26%）、60-69 岁（n = 309；35%）和<60 岁（n = 342；39%）。进行了多变量生存分析。
与年轻患者相比，老年患者严重（p < 0.01）和非手术（p < 0.001）术后并发症的发生率更高。主要估计出血量（EBL；p = 0.039）和合并症（p = 0.002）独立增加 PM。所有年龄组的 EBL 均相当。然而，与年轻患者相比，术前合并症、主要 EBL 和术后并发症明显降低了 OS。调整年龄后，OS 的独立预测因素为合并症（HR = 1.51；p = 0.001）、大肝切除术（HR = 1.33；p = 0.025）、EBL 增加（HR = 1.32；p = 0.031）和术后并发症（HR = 1.64；p < 0.001）。
尽管年龄增加不应成为肝切除术的禁忌症，但本研究强调了避免老年患者大量出血和基于术前合并症的严格患者选择。
