Outcome of right hepatectomies in patients older than 70 years

Hypothesis: The increasing number of elderly patients undergoing liver resections mandates updating of clinical outcomes on this specific population. Design: Case series. Setting: A tertiary care teaching hospital. Patients: Twenty-three patients older than 70 years who underwent right hepatectomies ( including 7 extended right hepatectomies) between January 1, 1995, and October 31, 2001 (group 1) and 99 patients younger than 7 0 years who underwent 64 right hepatectomies and 35 extended right hepatectomies during the same period (group 2) were included for a total sample population of 122. Main Outcome Measures: Preoperative chnicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, intensive care unit requirement, hospital stay, and course of main. biochemical liver function test results of groups 1 and 2 were analyzed and compared. Results: The 2 groups were similar for indications for surgery and the presence of underlying liver disease. Group 1 had a higher incidence of associated pulmonary diseases (21.7% vs 5%, P = .02) and patients With an American Society of Anesthesiologists score of III (i.e, a patient with severe systemic disease limiting activity, but not incapacitating) (56.5% vs 26.3% of cases, P = .01). There were no differences in intraoperative requirement of packed red blood cells and in operation time. There were no in-hospital deaths in group 1; there were 2 deaths (2%) in group 2. Nine patients (39.1%) in group I and 32 patients (32.3%) in group 2 experienced postoperative complications (P = .53), of whom, respectively, 5 (21.7%) and 17 (17.2%) developed transient liver dysfunction (P = .56), and 4 (17.4%) and 5 (5.1%) required a supplementary intesive care unit stay (P = .06). The postoperative stay (mean [SD], 16 [141]days vs 13 [9] days, P = .88) and peak values of the aminotransferase level, total serum bilirubin level, and prothrombin time were similar in the 2 groups. The timing of the peak Value of the total serum bilirubin level (mean [SD], 4.1[4.8] days vs 2.5 [2.5] days, P = .28). and its period of normalization (mean [SD], 9.4 [10.8] days vs 6.7 [5.1] days, P = .67) were also similar for both groups. For patients with malignancies, the 3-year survival rate was 64.2% in group I and 53.9% in group 2 (P =. 53). Conclusion: Being older than 70 years should not be a contraindication for major hepatectomies, provided that liver cirrhosis and severe associated medical conditions are ruled out during the preoperative evaluation.