1
|
Lee JS, Park DA, Ryoo S, Park J, Choi GH, Yoo JJ. Efficacy and Safety of Surgical Resection in Elderly Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis. Gut Liver 2024; 18:695-708. [PMID: 38712397 PMCID: PMC11249930 DOI: 10.5009/gnl230485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : With increased life expectancy, the management of elderly hepatocellular carcinoma (HCC) patients became a crucial issue, yet it is still challenging due to comorbidities and high surgical risks. While surgical resection is considered as primary treatment for eligible HCC patients, systematic evidence on its outcomes in elderly patients remains scarce. In this review, we aimed to analyze the efficacy and safety outcomes of surgical resection in elderly HCC patients. Methods : The studies included in this meta-analysis were selected from Ovid-MEDLINE, Ovid-Embase, CENTRAL, KoreaMed, KMbase, and KISS databases following a predefined protocol. Efficacy outcomes included overall survival and disease-free survival, while the safety outcomes included postoperative mortality and complications. Results : Patients in the elderly group (≥65 years) who underwent surgery exhibited non-inferior overall survival (hazard ratio [HR], 1.26; 95% confidence interval [CI], 0.92 to 1.74) and disease-free survival (HR, 1.03; 95% CI, 0.99 to 1.08) compared to the non-elderly group. Overall postoperative mortality exhibited no statistical difference (odds ratio [OR], 1.07; 95% CI, 0.87 to 1.31), but 30-day, 90-day, and in-hospital mortality were higher in the elderly group. The incidence of overall complications was higher in the elderly group (OR, 1.44; 95% CI, 1.22 to 1.69). Sensitivity analysis for the super elderly group (≥80 years) showed significantly higher in-hospital mortality compared to the non-super elderly group (OR, 2.51; 95% CI, 1.16 to 5.45). Conclusions : The efficacy outcome of surgical resection in the elderly HCC patients was not worse than that in the non-elderly HCC patients, while in-hospital mortality and complications rates were higher. Therefore, surgical resection should be purposefully considered in the elderly population, with careful candidate selection.
Collapse
Affiliation(s)
- Jin-Soo Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Asan, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Seungeun Ryoo
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jungeun Park
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Gi Hong Choi
- Department of General Surgery, Yonsei University School of Medicine, Seoul, Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Asan, Korea
| |
Collapse
|
2
|
Soyama A, Yamamoto H, Eguchi S, Nanashima A, Kakeji Y, Kitagawa Y, Nakamura M, Endo I. Short-term outcomes after liver resection with vascular reconstruction: Results from a study with the National Clinical Database of Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:425-436. [PMID: 38679741 DOI: 10.1002/jhbp.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Although curative resection with vascular reconstruction improves the prognosis of blood-invading locally advanced hepatobiliary tumors, the mortality and morbidity of the procedure remains unclear. This study aimed to clarify the risk factors associated with mortality and morbidity in patients undergoing liver resection with vascular reconstruction. METHODS This retrospective observational study included 1215 patients undergoing hepatectomy of more than one section with vascular reconstruction, except for left lateral sectionectomy registered in the National Clinical Database (NCD) between 2015 and 2019. The rates of surgical mortality and relevant clinical factors were evaluated. RESULTS Among the four types of vascular reconstruction, portal venous reconstruction was frequently performed in 724 patients (59.6% of the enrolled patients). Surgical mortality was 8.1%. Patients with hepatic artery reconstruction had the highest surgical mortality rate of 15.8%. In other types of reconstruction, surgical mortality was 9.1% in the portal vein, 5.2% in inferior vena cava, and 4.9% in hepatic vein. Factors significantly associated with surgical mortality include age, sex (male), preoperative comorbidity (American Society of Anesthesiologists grade >3, respiratory distress, diabetes, preoperative pneumonia, weight loss, and obstructive jaundice), poorer liver functional reserve (indocyanine green retention rate at 15 min and prothrombin time/international normalized ratio >1.1) and accompanying biliary reconstruction. CONCLUSIONS The NCD revealed the detailed status of liver resection combined with vascular reconstruction in Japan. Based on the results of this analysis, understanding the factors that influence the outcome and postoperative course of each procedure will provide patients with accurate information and opportunities to improve future outcomes.
Collapse
Affiliation(s)
- Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Itaru Endo
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| |
Collapse
|
3
|
Filippo R, Conticchio M, Ratti F, Inchingolo R, Gelli M, Anelli FM, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, Di Benedetto F, de'Angelis N, Briceno DFJ, Rampoldi AG, Adam R, Cherqui D, Aldrighetti L, Memeo R. Liver resection versus radiofrequency ablation in octogenarian patients for hepatocellular carcinoma: a propensity score multicenter analysis. Surg Endosc 2022; 37:3029-3036. [PMID: 36534162 DOI: 10.1007/s00464-022-09826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Liver resection (LR) and radiofrequency ablation (RFA) are considered curative options for hepatocellular carcinoma (HCC). The aim of this study was to compare outcomes after LR and RFA in octogenarian patients with HCC. MATERIALS AND METHODS This multicenter retrospective study included 102 elderly patients (> 80 years old) treated between January 2009 and January 2019, who underwent LR or RFA for HCC (65 and 37 with, respectively). RESULTS After Propensity Score Matching, the postoperative course of LR was burdened by a higher rate of complications than RFA group (64% vs 14%, respectively, p: 0.001). The LR group had also significantly longer operative time (207 ± 85 min vs 33 ± 49 min, p < 0.001) and postoperative hospital stays than the RFA group (7 d vs 2 d, p = 0.019). Overall survival at 1-, 2-, and 3-year were 86%, 86%, and 70% for the LR group and 82%, 64%, and 52% for the RFA group (p = 0.380). Disease-free survival at 1-, 2-, and 3-year were 89%, 74%, and 56% for the LR group, and 51%, 40%, and 40% for the RFA group (p = 0.037). CONCLUSION Despite a higher rate of Dindo-Clavien I-II post-operative complications, a longer operative time and length of hospital stay, LR in octogenarian patients can provide comparable 90d mortality than RFA and better long-term outcomes.
Collapse
Affiliation(s)
- Rosalinda Filippo
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Maria Conticchio
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy.
| | | | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" Regional General Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Maximiliano Gelli
- Département de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | | | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Giulio Cesare Vitali
- Service of Abdominal Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, MO, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, MO, Italy
| | - Emanuele Felli
- Institut de Recherche Contre les Cancers de L'Appareil Digestif (IRCAD), Strasbourg, France
| | - Taiga Wakabayashi
- Institut de Recherche Contre les Cancers de L'Appareil Digestif (IRCAD), Strasbourg, France
| | - Patrick Pessaux
- Institut de Recherche Contre les Cancers de L'Appareil Digestif (IRCAD), Strasbourg, France
| | - Tullio Piardi
- Department of Surgery, Hôpital Robert Debré, Reims, France
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, MO, Italy
| | - Nicola de'Angelis
- Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | | | | | - Renè Adam
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Villejuif, France
| | - Daniel Cherqui
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Villejuif, France
| | | | - Riccardo Memeo
- Division of Hepato-Pancreato-Biliary Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| |
Collapse
|
4
|
Vasavada B, Patel H. Postoperative mortality after liver resection for hepatocellular carcinoma‐ A systematic review. metanalysis and metaregression of studies published in last 5 years. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Bhavin Vasavada
- Department of hepatobiliary and liver transplant surgery Shalby Hospitals Ahmedabad
| | - Hardik Patel
- Department of hepatobiliary and liver transplant surgery Shalby Hospitals Ahmedabad
| |
Collapse
|
5
|
Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study. HPB (Oxford) 2021; 23:1506-1517. [PMID: 33926842 DOI: 10.1016/j.hpb.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection is high-risk surgery in particular in elderly patients. The aim of this study was to explore postoperative outcomes after liver resection in elderly patients. METHODS In this nationwide study, all patients who underwent liver resection for primary and secondary liver tumours in the Netherlands between 2014 and 2019 were included. Age groups were composed as younger than 70 (70-), between 70 and 80 (septuagenarians), and 80 years or older (octogenarians). Proportion of liver resections per age group and 30-day major morbidity and 30-day mortality were assessed. RESULTS In total, 6587 patients were included of whom 4023 (58.9%) were younger than 70, 2135 (32.4%) were septuagenarians and 429 (6.5%) were octogenarians. The proportion of septuagenarians increased during the study period (aOR:1.06, CI:1.02-1.09, p < 0.001). Thirty-day major morbidity was higher in septuagenarians (11%) and octogenarians (12%) compared to younger patients (9%, p = 0.049). Thirty-day mortality was higher in septuagenarians (4%) and octogenarians (4%) compared to younger patients (2%, p < 0.001). Cardiopulmonary complications occurred more frequently with higher age, liver-specific complications did not. Higher age was associated with higher 30-day morbidity and 30-day mortality in multivariable logistic regression. CONCLUSION Thirty-day major morbidity and 30-day mortality are higher after liver resection in elderly patients, attributed mainly to non-surgical cardiopulmonary complications.
Collapse
|
6
|
Loi M, Comito T, Franzese C, Desideri I, Dominici L, Lo Faro L, Clerici E, Franceschini D, Baldaccini D, Badalamenti M, Reggiori G, Lobefalo F, Scorsetti M. Charlson comorbidity index and G8 in older old adult(≥80 years) hepatocellular carcinoma patients treated with stereotactic body radiotherapy. J Geriatr Oncol 2021; 12:1100-1103. [PMID: 33461945 DOI: 10.1016/j.jgo.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/16/2020] [Accepted: 01/05/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hepatocellular Carcinoma (HCC) is characterized, in Western countries, by higher incidence and mortality rates in the older adult population. In frail patients, limited therapeutic resources are available due to limited expected benefit concerning the risk of treatment-related toxicity. The aim of our study is to evaluate the role of Stereotactic Body Radiotherapy (SBRT) in the clinical management of older old adults (age ≥ 80 years) HCC patients and to identify predictors of efficacy and toxicity. MATERIAL AND METHODS Clinical and treatment-related data of older old adults HCC patients treated with SBRT at our institution were retrospectively reviewed. Statistical analysis was carried out to identify variables correlated with impaired outcome and toxicity. RESULTS Forty-two patients were included, accounting for 63 treated tumors. Median age was 85 (range 80-91) years. Median Charlson Comorbidity Index (CCI) and G8 scores were 10 (range 7-16) and 11 (range 8-14), respectively. SBRT was administered to a median BED10 of 103 Gy10. Median follow-up interval was 11 (range 3-40) months. Two years Local Control (LC), Progression-Free Survival (PFS), and Overall Survival (OS) were 93%, 31%, and 43%, respectively. Acute toxicity occurred in 28% (n = 13) of treatments. A G8 score > 10 was associated with improved survival (p = 0.045), while a CCI ≥10 was correlated with increased acute toxicity (p = 0.021). CONCLUSIONS SBRT is a safe and effective option in older old adults HCC patients. A comprehensive geriatric assessment (CGA) is advised before treatment decisions to select optimal candidates for SBRT.
Collapse
Affiliation(s)
- Mauro Loi
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy.
| | - Tiziana Comito
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Ciro Franzese
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Radiotherapy Department, University of Florence, Florence, Italy
| | - Isacco Desideri
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan Area, Italy
| | - Luca Dominici
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan Area, Italy
| | - Lorenzo Lo Faro
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Elena Clerici
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Davide Franceschini
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Davide Baldaccini
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Marco Badalamenti
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Giacomo Reggiori
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Francesca Lobefalo
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Center, IRCCS, Radiotherapy and Radiosurgery Department, Rozzano, Italy; Radiotherapy Department, University of Florence, Florence, Italy
| |
Collapse
|