Santambrogio Roberto, Barabino Matteo, Scifo Giovanna, Costa Mara, Giovenzana Marco, Opocher Enrico
UOC di Chirurgia Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, via A. di Rudini' 8, 20142, Milan, Italy.
J Gastrointest Surg. 2017 Apr;21(4):657-665. doi: 10.1007/s11605-016-3354-1. Epub 2017 Jan 12.
Thanks to technical advancement in surgery for hepatocellular carcinoma (HCC), hepatic resection (HR) for elderly HCC patients has become safer. However, elderly patients may have shorter long-term survival after surgery if compared with younger patients because of their expected life span. The aim of the present study was to evaluate clinical outcomes and safety after HR in HCC patients aged >75 years (older) compared with HCC patients aged <75 years (younger).
One hundred sixty-eight patients who underwent HR for HCC from 1998 to 2015 in our Center were analyzed using a prospective database. Complications, disease-free survival rates, and cumulative survival rates were compared between the two groups.
During the immediate postoperative period, no differences were found about liver-related complications, hospital stay and 90-day mortality. However, older patients had more complications in class II or higher (Clavien classification) (p = 0.017). Although disease-free survival in both groups was similar (p = 0.099), overall survival was worse in the elderly group (p = 0.024). On multivariate analysis, only age ≥75 years was significantly related to overall survival.
If elderly patients with liver cirrhosis and HCC are appropriately selected and evaluated, they might have favorable prognoses after HR.
由于肝细胞癌（HCC）手术技术的进步，老年HCC患者的肝切除术（HR）已变得更安全。然而，与年轻患者相比，老年患者由于预期寿命的原因，术后长期生存率可能较短。本研究的目的是评估年龄>75岁（老年）的HCC患者与年龄<75岁（年轻）的HCC患者行HR后的临床结局和安全性。
使用前瞻性数据库分析了1998年至2015年在本中心接受HR治疗HCC的168例患者。比较两组之间的并发症、无病生存率和累积生存率。
在术后即刻，两组在肝脏相关并发症、住院时间和90天死亡率方面未发现差异。然而，老年患者在II级或更高等级（Clavien分级）的并发症更多（p = 0.017）。虽然两组的无病生存率相似（p = 0.099），但老年组的总生存率较差（p = 0.024）。多因素分析显示，只有年龄≥75岁与总生存率显著相关。
如果对老年肝硬化合并HCC患者进行适当的选择和评估，他们行HR后可能有良好的预后。
