Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
The ageing population raises concerns about the adequacy of aggressive surgical procedures and their outcomes. The treatment of the elderly with hepatocellular carcinoma is one of the diseases that involve complicated management decisions. We set out to compare the results between an older and younger patient cohort with this disease are compared.
MATERIAL AND METHODS:
A total of 36 hepatic resections were performed on patients with hepatocellular carcinoma between 2000 and 2011. The cohort was divided into 2 groups (14 patients < 70 and 22 patients ≥ 70 years of age), and their results, disease free and overall survival were compared using Kaplan-Meir curves and log rank test. An attempt was also made at determining the predictive factors of a poor outcome among this patient cohort.
Both groups were similar with regards to their pre-operative status. Operation time, procedure, hospital stay, and morbidity and mortality were similar. Overall survival at 3 and 5 years comparing the younger vs. the elderly group was 85.7% vs. 68.7% and 47.6% vs. 60%, respectively (P=.813). Disease free survival at 3 and 5 years comparing the younger vs. the elderly group was 69.3% vs. 35.2% and 39.6% vs. 23.4%, respectively (P=.539). Multivariate analysis of the whole cohort revealed multicentric diseases and elevated alpha-fetoprotein as independent factors of poor disease free survival and overall survival, respectively.
Elderly patients with hepatocellular carcinoma should be managed in a similar fashion to younger patients. Surgeons should expect similar post-operative complications, disease free and overall survival.