nach oben

Erschienen in:

31.05.2021 | Original Article

Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications

verfasst von: Kenji Yoshino, Yanis Hamzaoui, Tomoaki Yoh, Fadhel Samir Ftériche, Béatrice Aussilhou, Aurélie Beaufrère, Jacques Belghiti, Olivier Soubrane, François Cauchy, Safi Dokmak

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The prolonged life expectancy and increase in aging of the population have led surgeons to propose hepatectomy in the elderly population. In this study, we evaluate the surgical outcome of octogenarians in a single French center.

Methods

Between 2000 and 2020, 78 patients over 80 years old were retrospectively analyzed. The risk factors of major complications (Clavien-Dindo ≥ grade IIIa) and patient performance after surgery by using textbook outcome (TO) (no surgical complications, no prolonged hospital stay (≤ 15 days), no readmission ≤90 days after discharge, and no mortality ≤90 days after surgery) were studied.

Results

The main surgical indication was for malignancy (96%), including mainly colorectal liver metastases (n = 41; 53%) and hepatocellular carcinoma (n = 22; 28%), and major hepatectomy was performed in 28 patients (36%). There were 6 (8%) postoperative mortalities. The most frequent complications were pulmonary (n = 22; 32%), followed by renal insufficiency (n = 22; 28%) and delirium (n = 16; 21%). Major complications occurred in 19 (24%) patients. On multivariate analysis, the main risk factors for major complications were the median vascular clamping time (0 vs 35; P = 0.04) and male sex (P = 0.046). TO was ultimately achieved in 30 patients (38%), and there was no prognostic factor for achievement of TO.

Conclusions

Hepatectomy in octogenarians is associated with acceptable morbidity and mortality. Meanwhile, prolonged hepatic pedicle clamping should be avoided especially if hepatectomy is planned in a male patient.

Nur mit Berechtigung zugänglich

Nishikawa H, Kimura T, Kita R, Osaki Y (2013) Treatment for hepatocellular carcinoma in elderly patients: a literature review. J Cancer 4(8):635–643. https://doi.org/10.7150/jca.7279CrossRefPubMedPubMedCentral

Okamura Y, Sugiura T, Ito T, Yamamoto Y, Ashida R, Uesaka K (2018) The short- and long-term outcomes in elderly patients with hepatocellular carcinoma after curative surgery: a case-controlled study with propensity score matching. Eur Surg Res 59(5-6):380–390. https://doi.org/10.1159/000494733CrossRefPubMed

Phan K, An VV, Ha H, Phan S, Lam V, Pleass H (2015) Hepatic resection for malignant liver tumours in the elderly: a systematic review and meta-analysis. ANZ J Surg 85(11):815–822. https://doi.org/10.1111/ans.13211CrossRefPubMed

Shin J, Yu JH, Jin YJ, Suh YJ, Kim DH, Byun S, Lee JW (2019) Effective therapeutic options for elderly patients with hepatocellular carcinoma: a nationwide cohort study. Medicine (Baltimore) 98(30):e16150. https://doi.org/10.1097/md.0000000000016150CrossRef

Nomi T, Hirokawa F, Kaibori M et al (2019) Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a multi-centre propensity score-based analysis. Surg Endosc. https://doi.org/10.1007/s00464-019-06812-z

Gandy RC, Stavrakis T, Haghighi KS (2018) Short- and long-term outcomes of elderly patients undergoing liver resection for colorectal liver metastasis. ANZ J Surg 88(3):E103–e107. https://doi.org/10.1111/ans.13690CrossRefPubMed

Dokmak S, Fteriche FS, Borscheid R, Cauchy F, Farges O, Belghiti J (2013) 2012 Liver resections in the 21st century: we are far from zero mortality. HPB (Oxford) 15(11):908–915. https://doi.org/10.1111/hpb.12069CrossRef

Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepato-Biliary-Pancreat Surg 12(5):351–355. https://doi.org/10.1007/s00534-005-0999-7CrossRef

Miskovic A, Lumb AB (2017) Postoperative pulmonary complications. Br J Anaesth 118(3):317–334. https://doi.org/10.1093/bja/aex002CrossRefPubMed

10.

Choi SW, Shin WY, Lee KY, Ahn SI (2016) Risk factors of postoperative ascites on hepatic resection for hepatocellular carcinoma. Ann Hepatobiliary Pancreat Surg 20(4):153–158. https://doi.org/10.14701/ahbps.2016.20.4.153CrossRefPubMedPubMedCentral

11.

Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242(6):824–828, discussion 828-9. https://doi.org/10.1097/01.sla.0000189131.90876.9eCrossRefPubMedPubMedCentral

12.

Rahbari NN, Garden OJ, Padbuy R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149(5):713–724. https://doi.org/10.1016/j.surg.2010.10.001CrossRefPubMed

13.

Kolfschoten NE, Kievit J, Leesum NJ, Snijders HS, Eddes EH, Tollemm RAEM, Wouters MWJM, de Mheen PJM (2013) Focusing on desired outcomes of care after colon cancer resections; hospital variations in ‘textbook outcome’. Eur J Surg Oncol 39(2):156–163. https://doi.org/10.1016/j.ejso.2012.10.007CrossRefPubMed

14.

Merath K, Chen Q, Bagante F, Beal E, Akgul O, Dillhoff M, Cloyd JM, Pawlik TM (2018) Textbook outcomes among Medicare patients undergoing hepatopancreatic surgery. Ann Surg. https://doi.org/10.1097/sla.0000000000003105

15.

Wu CC, Chen JT, Ho WL, Yeh DC, Tang JS, Liu TJ, Peng FK (1999) Liver resection for hepatocellular carcinoma in octogenarians. Surgery 125(3):332–338CrossRef

16.

Riffat F, Chu F, Morris DL (2006) Liver resection in octogenarians. HPB (Oxford) 8(3):206–210. https://doi.org/10.1080/13651820500497173CrossRef

17.

Shirabe K, Kajiyama K, Harimoto N, Gion T, Tsujita E, Abe T, Wakiyama S, Nagaie T, Maehara Y (2009) Early outcome following hepatic resection in patients older than 80 years of age. World J Surg 33(9):1927–1932. https://doi.org/10.1007/s00268-009-0122-3CrossRefPubMed

18.

Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, Ichikawa T, Sawai T, Yasutake T, Nakao K, Nagayasu T (2011) Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery? J Surg Oncol 104(3):284–291. https://doi.org/10.1002/jso.21932CrossRefPubMed

19.

Yamada S, Shimada M, Miyake H, Utsunomiya T, Morine Y, Imura S, Ikemoto T, Mori H, Hanaoka J, Iwahashi S, Saito Y (2012) Outcome of hepatectomy in super-elderly patients with hepatocellular carcinoma. Hepatol Res 42(5):454–458. https://doi.org/10.1111/j.1872-034X.2011.00952.xCrossRefPubMed

20.

Takahashi Y, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M (2013) Surgical treatment of perihilar cholangiocarcinoma in octogenarians: a single center experience. J Hepatobiliary Pancreat Sci 20(3):324–331. https://doi.org/10.1007/s00534-012-0529-3CrossRefPubMed

21.

Nozawa A, Kubo S, Takemura S, Sakata C, Urata Y, Nishioka T, Kinoshita M, Hamano G, Uenishi T, Suehiro S (2015) Hepatic resection for hepatocellular carcinoma in super-elderly patients aged 80 years and older in the first decade of the 21st century. Surg Today 45(7):851–857. https://doi.org/10.1007/s00595-014-0994-1CrossRefPubMed

22.

Leal JN, Sadot E, Gonen M, Lichtman S, Kingham TP, Allen PJ, DeMatteo RP, Jarnagin WR, D’Angelica MI (2017) Operative morbidity and survival following hepatectomy for colorectal liver metastasis in octogenarians: a contemporary case matched series. HPB (Oxford) 19(2):162–169. https://doi.org/10.1016/j.hpb.2016.09.009CrossRef

23.

Hamaoka M, Kobayashi T, Ishiyama K, Ohira M, Tahara H, Kuroda S, Iwako H, Okimoto S, Honmyo N, Ohdan H (2017) Evaluation of the risk factors and prognostic factors of hepatectomy for hepatocellular carcinoma in patients aged 80 years or more. J Hepatobiliary Pancreat Sci 24(1):58–64. https://doi.org/10.1002/jhbp.413CrossRefPubMed

24.

Gupta AK, Kanhere HA, Maddern GJ, Trochsler MI (2018) Liver resection in octogenarians: are the outcomes worth the risk? ANZ J Surg 88(11):E756–e760. https://doi.org/10.1111/ans.14475CrossRefPubMed

25.

Akashi K, Ebata T, Mizuno T, Yokoyama Y, Igami T, Yamaguchi J, Onoe S, Nagino M (2018) Surgery for perihilar cholangiocarcinoma from a viewpoint of age: is it beneficial to octogenarians in an aging society? Surgery 164(5):1023–1029. https://doi.org/10.1016/j.surg.2018.05.051CrossRefPubMed

26.

De Blasi V, Memeo R, Adam R et al (2018) Major hepatectomy for colorectal liver metastases in patients aged over 80: a propensity score matching analysis. Dig Surg 35(4):333–341. https://doi.org/10.1159/000486522CrossRefPubMed

27.

Horiuchi T, Haruki K, Shiba H, Sakamoto T, Saito N, Shirai Y, Iwase R, Fujiwara Y, Yanaga K (2019) Assessment of outcome of hepatic resection for extremely elderly patients with a hepatic malignancy. Anticancer Res 39(9):5143–5148. https://doi.org/10.21873/anticanres.13709CrossRefPubMed

28.

Lallement M, Maulat C, Suc B, Pere G, Lozano S, Berard E, Muscari F (2020) Short-term autonomy and survival after hepatectomy in the elderly. J Visc Surg. https://doi.org/10.1016/j.jviscsurg.2020.01.001

29.

Shimada S, Kamiyama T, Orimo T, Nagatsu A, Asahi Y, Sakamoto Y, Kamachi H, Taketomi A (2020) Prognoses, outcomes, and clinicopathological characteristics of very elderly patients with hepatocellular carcinoma who underwent hepatectomy. World J Surg Oncol 18(1):122. https://doi.org/10.1186/s12957-020-01899-4CrossRefPubMedPubMedCentral

30.

Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ (2010) Liver resection of colorectal metastases in elderly patients. Br J Surg 97(3):366–376. https://doi.org/10.1002/bjs.6889CrossRefPubMed

31.

Reddy SK, Barbas AS, Turley RS, Gamblin TC, Geller DA, Marsh JW, Tsung A, Clary BM, Deenadayalan SL (2011) Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg 212(5):787–795. https://doi.org/10.1016/j.jamcollsurg.2010.12.048CrossRefPubMed

32.

Figueras J, Ramos E, Ben SL, Torras J, Albiol M, Llado L, Gonzalez HD, Rafecas A (2007) Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? Clin Transl Oncol 9(6):392–400CrossRef

33.

Cook EJ, Welsh FK, Chandrakumaran K, John TG, Rees M (2012) Resection of colorectal liver metastases in the elderly: does age matter? Color Dis 14(10):1210–1216. https://doi.org/10.1111/j.1463-1318.2012.02946.xCrossRef

34.

Fukuoka K, Nara S, Honma Y, Kishi Y, Esaki M, Shimada K (2017) Hepatectomy for colorectal cancer liver metastases in the era of modern preoperative chemotherapy: evaluation of postoperative complications. World J Surg 41(4):1073–1081. https://doi.org/10.1007/s00268-016-3724-6CrossRefPubMed

35.

Takahashi H, Mizuta T, Kawazoe S, Eguchi Y, Kawaguchi Y, Otsuka T, Oeda S, Ario K, Iwane S, Akiyama T, Ozaki I, Fujimoto K (2010) Efficacy and safety of radiofrequency ablation for elderly hepatocellular carcinoma patients. Hepatol Res 40(10):997–1005. https://doi.org/10.1111/j.1872-034X.2010.00713.xCrossRefPubMed

36.

Merath K, Chen Q, Bagante F et al (2019) A multi-institutional international analysis of textbook outcomes among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. JAMA Surg 154(6):e190571. https://doi.org/10.1001/jamasurg.2019.0571CrossRefPubMedPubMedCentral

37.

Man K, Fan ST, Ng IO, Lo CM, Liu CL, Wong J (1997) Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 226(6):704–711; discussion 711-3. https://doi.org/10.1097/00000658-199712000-00007CrossRefPubMedPubMedCentral

38.

Gong C, Wang H, Liu P, Guo T (2017) Impact of intraoperative vascular occlusion during liver surgery on long-term outcomes: a systematic review and meta-analysis. Int J Surg 44:110–116. https://doi.org/10.1016/j.ijsu.2017.06.050CrossRefPubMed

39.

Cauchy F, Zalinski S, Dokmak S, Fuks D, Farges O, Castera L, Paradis V, Belghiti J (2013) Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg 100(1):113–121. https://doi.org/10.1002/bjs.8963CrossRefPubMed

40.

Petrowsky H, McCormack L, Trujillo M, Selzner M, Jochum W, Clavien PA (2006) A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection. Ann Surg 244(6):921–928; discussion 928-30. https://doi.org/10.1097/01.sla.0000246834.07130.5dCrossRefPubMedPubMedCentral

41.

Cassuto JR, Patel SA, Tsoulfas G, Orloff MS, Abt PL (2008) The cumulative effects of cold ischemic time and older donor age on liver graft survival. J Surg Res 148(1):38–44. https://doi.org/10.1016/j.jss.2008.03.018CrossRefPubMed

42.

Ghinolfi D, Lai Q, Pezzati D, De Simone P, Rreka E, Filipponi F (2018) Use of elderly donors in liver transplantation: a paired-match analysis at a single center. Ann Surg 268(2):325–331. https://doi.org/10.1097/sla.0000000000002305CrossRefPubMed

43.

Reese PP, Sonawane SB, Thomasson A, Yeh H, Markmann JF (2008) Donor age and cold ischemia interact to produce inferior 90-day liver allograft survival. Transplantation 85(12):1737–1744. https://doi.org/10.1097/TP.0b013e3181722f75CrossRefPubMed

44.

Etele EE, Sala D, Denes M, Cozlea A, Darie R, Torok A (2019) Elderly patients with colorectal cancer - a predisposed category for postoperative complications. Chirurgia (Bucur) 114(3):331–342. https://doi.org/10.21614/chirurgia.114.3.331CrossRef

45.

Kirchhoff P, Dincler S, Buchmann P (2008) A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg 248(2):259–265. https://doi.org/10.1097/SLA.0b013e31817bbe3aCrossRefPubMed

Titel: Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications
verfasst von: Kenji Yoshino
Yanis Hamzaoui
Tomoaki Yoh
Fadhel Samir Ftériche
Béatrice Aussilhou
Aurélie Beaufrère
Jacques Belghiti
Olivier Soubrane
François Cauchy
Safi Dokmak
Publikationsdatum: 31.05.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 5/2021
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02210-z

Neu im Fachgebiet Chirurgie

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Liver resection for octogenarians in a French center: prolonged hepatic pedicle occlusion and male sex increase major complications