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World J Gastroenterol. Nov 7, 2014; 20(41): 15028-15036
Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15028
Safety of hepatectomy for elderly patients with hepatocellular carcinoma
Koichi Oishi, Toshiyuki Itamoto, Toshihiko Kohashi, Yasuhiro Matsugu, Hideki Nakahara, Mikiya Kitamoto
Koichi Oishi, Toshiyuki Itamoto, Toshihiko Kohashi, Yasuhiro Matsugu, Hideki Nakahara, Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Toshiyuki Itamoto, Faculty of Medicine, Hiroshima University, Hiroshima 734-8551, Japan
Mikiya Kitamoto, Department of Hepatology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
Author contributions: Oishi K, Itamoto T, Kohashi T, Matsugu Y, Nakahara H and Kitamoto M analyzed the data; Oishi K and Itamoto T wrote the paper.
Correspondence to: Koichi Oishi, MD, Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujina-Kanda Minami-ku, Hiroshima 734-8530, Japan. koishi@enjoy.ne.jp
Telephone: +81-82-2541818 Fax: +81-82-2538274
Received: March 12, 2014
Revised: May 11, 2014
Accepted: July 22, 2014
Published online: November 7, 2014
Abstract

The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing. Characteristics of elderly HCC patients are a higher proportion of females, a lower rate of positive hepatitis B surface antigen, and a higher rate of positive hepatitis C antibodies. Careful patient selection is vital for performing hepatectomy safely in elderly HCC patients. Treatment strategy should be decided by not only considering tumor stage and hepatic functional reserve, but also physiological status, including comorbid disease. Various assessment tools have been applied to predict the risk of hepatectomy. The reported mortality and morbidity rates after hepatectomy in elderly HCC patients ranged from 0% to 42.9% and from 9% to 51%, respectively. Overall survival rate after hepatectomy in elderly HCC patients at 5 years ranged from 26% to 75.9%. Both short-term and long-term results after hepatectomy for strictly selected elderly HCC patients are almost the same as those for younger patients. However, considering physiological characteristics and the high prevalence of comorbid disease in elderly patients, it is important to assess patients more meticulously and to select them strictly if scheduled to undergo major hepatectomy.

Keywords: Hepatocellular carcinoma, Hepatectomy, Elderly

Core tip: The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing. Careful patient selection is vital for performing hepatectomy safely in elderly HCC patients. Treatment strategy should be decided by not only considering tumor stage and hepatic functional reserve, but also physiological status, including comorbid disease. Both short-term and long-term results after hepatectomy for strictly selected elderly HCC patients are almost the same as those for younger patients. However, considering physiological characteristics and the high prevalence of comorbid disease in elderly patients, it is important to assess patients more meticulously if scheduled to undergo major hepatectomy.