Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan,
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
Dig Surg. 2019;36(4):289-301. doi: 10.1159/000488327. Epub 2018 May 14.
The rising proportion of elderly patients (aged 80 yearsor above) in our population means that more elderly patients are undergoing hepatectomy.
Five-hundred and thirty patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were retrospectively analyzed with respect to their preoperative status and perioperative results, including remnant liver regeneration. The remnant liver volume was postoperatively measured with multidetector CT on postoperative day 7 and 1, 2, 5, and 12 months after surgery. An elderly group (aged 80 or older) was compared with a non-elderly group (aged less than 80 years).
Underlying diseases of the cardiovascular system were significantly more common in the elderly group (57.8%, p = 0.0008). The postoperative incidence of Clavien-Dindo Grade IIIa or higher complications was 20.0% in the elderly group and 24.3% in the non-elderly group, and this difference was not significant. As for regeneration of the remnant liver after resection, this was not morphologically delayed compared to the non-elderly group.
In this study, we have demonstrated that safe, radical hepatectomy, similar to procedures performed on non-elderly patients, can be performed on patients with HCC aged 80 and older with sufficient perioperative care.
随着人口老龄化的加剧，80 岁及以上的老年患者在我们的人群中所占比例越来越高，这意味着越来越多的老年患者需要接受肝切除术。
回顾性分析了 530 例因肝细胞癌（HCC）接受肝切除术的患者的术前状况和围手术期结果，包括残肝再生情况。术后第 7 天、1 天、2 天、5 天和 12 个月，采用多排螺旋 CT 测量术后残肝体积。将老年组（年龄 80 岁及以上）与非老年组（年龄<80 岁）进行比较。
老年组患者心血管系统基础疾病明显更为常见（57.8%，p=0.0008）。老年组术后 Clavien-Dindo 分级 IIIa 或更高并发症的发生率为 20.0%，非老年组为 24.3%，差异无统计学意义。就切除后残肝的再生而言，与非老年组相比，其形态上没有延迟。
在这项研究中，我们证明了在充分的围手术期护理下，安全、根治性的肝切除术可以安全地应用于年龄在 80 岁及以上的 HCC 患者，与非老年患者的手术方式相似。
