Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
J Surg Res. 2019 Jul;239:92-97. doi: 10.1016/j.jss.2019.01.058. Epub 2019 Feb 26.
In recent years, laparoscopic liver resection has elicited growing attention as a safe procedure for various forms of hepatic resection. In the context of an aging population, this study aims to evaluate outcomes in elderly patients (>70 y) compared with younger patients (≤70 y).
All consecutive patients undergoing minimally invasive liver resections between December 2013 and January 2018 at the Department of Surgery, Charité-Universitätsmedizin Berlin, were included in this analysis. Patients' characteristics, such as body mass index, American Society of Anesthesiologists classification, as well as underlying liver disease and function, were examined and the perioperative outcomes of patients aged >70 y (group 1; G1) contrasted with patients aged ≤ 70 y (group 2; G2).
Of 250 patients, 67 were >70 y old (G1) and 183 were ≤70 y old (G2). Patients in G1 were characterized by a higher body mass index (27.6 kg/mversus 24.9 kg/m; P = 0.004) and impaired physical states (American Society of Anesthesiologists score III/IV; 60% versus 37%; P = 0.002) when compared with group 2. G1 also exhibited higher rates of primary and secondary hepatic malignancies (G1: n = 62; 92.5%; G2: n = 115, 62.8%; P = 0.031) in addition to higher rates of cirrhosis (G1: n = 30, 44.8%; G2: n = 38, 20.8%; P = <0.001). The rate of major complications (Dindo-Clavien grade ≥ III) was similar between both groups (P = 0.58), with no differences regarding resection extent (P = 0.469). No difference was evident with regard to the median intensive care unit (median 1 versus 1 d; range, G1, 0-8 d, G2, 0-23 d; P = 0.1). However, we observed a significant longer hospital stay in G1 of 1 d (median 8 versus 9 d; G1 range: 4-35 d: G2 range: 4-59 d; P = 0.015).
Minimally invasive liver resection is a feasible and safe procedure in elderly patients despite this age group exhibiting a higher rate of primary and secondary malignancy and cirrhosis, as well as an overall more severely compromised physical health when compared with patients under the age of 70 y. Therefore, it stands to reason that patients in poorer general health might particularly benefit from a minimally invasive approach.
近年来，腹腔镜肝切除术因其在各种形式的肝切除中的安全性而备受关注。在人口老龄化的背景下，本研究旨在评估>70 岁老年患者与≤70 岁患者的结局。
本研究纳入了 2013 年 12 月至 2018 年 1 月期间在柏林夏里特医科大学外科接受微创肝切除术的所有连续患者。检查了患者的特征，如体重指数、美国麻醉师协会分类，以及潜在的肝脏疾病和功能，并比较了>70 岁（组 1；G1）和≤70 岁（组 2；G2）患者的围手术期结局。
在 250 名患者中，67 名年龄>70 岁（G1），183 名年龄≤70 岁（G2）。与 G2 相比，G1 患者的体重指数更高（27.6kg/m2 与 24.9kg/m2；P=0.004），身体状况更差（美国麻醉师协会评分 III/IV；60%与 37%；P=0.002）。G1 原发性和继发性肝癌的发生率也更高（G1：n=62；92.5%；G2：n=115，62.8%；P=0.031），肝硬化的发生率也更高（G1：n=30，44.8%；G2：n=38，20.8%；P<0.001）。两组之间主要并发症（Dindo-Clavien 分级≥III）的发生率相似（P=0.58），手术范围也无差异（P=0.469）。两组患者的重症监护病房中位时间（中位数 1 天与 1 天；范围，G1：0-8 天，G2：0-23 天；P=0.1）无差异。然而，我们观察到 G1 的住院时间明显延长，为 1 天（中位数 8 天与 9 天；G1 范围：4-35 天；G2 范围：4-59 天；P=0.015）。
尽管>70 岁老年患者原发性和继发性恶性肿瘤以及肝硬化的发生率更高，整体身体状况更差，但微创肝切除术在老年患者中是一种可行且安全的方法。因此，身体状况较差的患者可能特别受益于微创方法。
