Department of Surgery, Kansai Medical University, Osaka, Japan.
Asian Pac J Cancer Prev. 2023 Mar 1;24(3):1089-1094. doi: 10.31557/APJCP.2023.24.3.1089.
Liver resection in the super elderly patients remains challenging because of comorbidities and operative tolerability.
In this study, we compared postoperative complications and survival in patients aged ≥85 yr included five patients aged ≥90 yr with those aged 70-79 and 80-84 yr at a single institution.
Three hundred sixty-seven patients aged ≥70 yr underwent liver resection and were divided into three groups based on age at operation between 2010 and 2022; (a) 70-79 yr (median of 74 yr, n=245), (b) 80-84 yr (median of 82 yr, n=81), and (c) ≥85 yr (median of 87 yr, n=41). In the ≥85 yr group (90-yr-old group), twenty-five patients (four) had hypertension, fourteen (one) had diabetes mellitus, seven (one) had cardiovascular disease, and five patients (one) had dementia. The rate of comorbidities did not differ significantly among three groups. The rate of postoperative complications (Clavien-Dindo grade 3a≤) was 25% in the 70- to 79-yr-old group, 27% in the 80- to 84-yr-old group, and 17% in the ≥85-yr-old group (20% in the ≥90-yr-old group) (N.S.). The 1- and 5-yr patient survival rates in the ≥85-yr-old group were 90.1% and 48.5% respectively, compared with 86.7% and 60.9% in the 70- to 79-yr-old group and 83.8% and 66.3% in the 80- to 84-yr-old group, respectively (N.S.).
Despite the management of comorbidities, liver resection for well-selected super elderly patients, such as those aged ≥85 yr included ≥90yr, has acceptable outcomes. The age of patient is not an absolute contraindication to liver resection.
由于合并症和手术耐受性，高龄患者的肝切除术仍然具有挑战性。
本研究比较了在一家医疗机构接受手术的年龄≥85 岁的 5 例≥90 岁患者与年龄为 70-79 岁和 80-84 岁的患者的术后并发症和生存情况。
367 例年龄≥70 岁的患者接受了肝切除术，并根据 2010 年至 2022 年的手术年龄分为三组；（a）70-79 岁（中位年龄 74 岁，n=245）、（b）80-84 岁（中位年龄 82 岁，n=81）和（c）≥85 岁（中位年龄 87 岁，n=41）。在≥85 岁组（90 岁组）中，25 例（4 例）患有高血压，14 例（1 例）患有糖尿病，7 例（1 例）患有心血管疾病，5 例（1 例）患有痴呆症。三组之间的合并症发生率无显著差异。术后并发症发生率（Clavien-Dindo 分级 3a≤）在 70-79 岁组为 25%，80-84 岁组为 27%，≥85 岁组为 17%（≥90 岁组为 20%）（N.S.）。≥85 岁组的 1 年和 5 年患者生存率分别为 90.1%和 48.5%，而 70-79 岁组分别为 86.7%和 60.9%，80-84 岁组分别为 83.8%和 66.3%（N.S.）。
尽管对合并症进行了管理，但对精心选择的超老年患者（如年龄≥85 岁，包括≥90 岁）进行肝切除术具有可接受的结果。患者年龄不是肝切除术的绝对禁忌证。
