Hepatic resection for hepatocellular carcinoma in the elderly

BACKGROUND: Although the number of elderly people undergoing surgery for he patocellular carcinoma (HCC) has increased because of the prolonged life ex pectancy rate, potential benefits of hepatectomy for elderly patients with HCC have not been fully delineated. STUDY DESIGN: Using medical records, surgical outcomes of HCC in 103 patien ts 70 years of age or older undergoing hepatic resection (older group) were clarified and compared with those of 283 patients younger than 70 years of age (younger group) in this retrospective study. Postresection prognostic factors were evaluated by multivariate analysis using Cox's proportional ha zards model. RESULTS: There were no significant differences in postoperative complicatio n, operative mortality and overall hospital death rates between the two gro ups. Overall 3- and 5-year survival rates for the older group and the young er group were 51.0% versus 55.2%, and 42.2% versus 40.0%, respectively (p = 0.95). Disease-free 3- and 5-year survival rates for the older group and t he younger group were 35.2% versus 37.6%, and 16.6% versus 24.2%, respectiv ely (p = 0.66). Multivariate analysis revealed that the presence of liver c irrhosis and vascular invasion were independently significant factors of po or overall survival. CONCLUSIONS: Selected elderly patients with HCC benefited from resection as much as young patients, and age by itself may not be a contraindication to surgery. Postresection longterm prognosis in the elderly was determined by the presence of liver cirrhosis and vascular invasion. (J Am Coll Surg 200 1;112:38-46. (C) 2001 by the American College of Surgeons).