Oncological liver resection in elderly - A retrospective comparative study

Background: Due to demographic changes and higher life expectancy especially in industrial nations, the number of liver resections in patients >= 70 years is rising. It is known that older age is associated with higher post-operative morbidity and mortality after surgery under general anesthesia. The aim of this analysis is to compare the postoperative outcome after liver resections for malignancies in patients aged below and above 70 years. Materials and methods: A prospectively collected electronic database of 1034 liver resections between January 2013 and December 2019 was retrospectively analyzed. Comparative analysis of patients < 70 and >= 70 years receiving liver resections for malignancies included 889 operations in 703 patients. Analysis of postoperative outcome and uni-and multivariate analyses of associated risk factors were performed. Results: Median age of the whole cohort was 65 years (range 18-87 years). N = 582 liver resections (65.7%) were performed in patients < 70 years with 42.8% major hepatectomies and n = 307 (34.3%) liver resections in pa-tients >= 70 years with 50.5% major hepatectomies (p = 0.034). Relevant postoperative morbidity of the whole cohort was 27.9%. The 30-day mortality was 3.9% and re-operation rate 14.8%. Patients >= 70 years had significantly higher postoperative morbidity and mortality rates than patients < 70 years. Major resections, longer operating time, need of intraoperative transfusions of blood products as well as biliodigestive anastomosis (BDA) and inferior vena cava (IVC) resection were independent risk factors for worse postoperative outcome. Conclusion: Liver resections in patients >= 70 years are associated with a worse postoperative course after. Parenchyma sparing resections should be preferred in those patients.

Automated summary

Due to demographic changes and higher life expectancy, the number of liver resections in patients aged 70 and above is increasing. This analysis compared the postoperative outcome between patients below and above 70 years old who underwent liver resections for malignancies. The results showed that patients aged 70 and above had higher rates of postoperative complications and mortality compared to younger patients. Factors such as major resections, longer operating time, blood transfusion requirement, and certain organ resections were associated with worse postoperative outcomes.