Liver resection in hepatitis B related-hepatocellular carcinoma: Clinical outcomes and safety in elderly patients

Table 1 Clinical characteristics in elderly and younger hepatitis B virus-related hepatocellular carcinoma patients n (%)

Clinicalcharacteristics	Elderly (≥ 65 yr)(n = 207)	Younger (< 65 yr)(n = 1336)	P value
Age (yr), median (IQR)	68 (66-73)	47 (40-56)	< 0.001
Male	166 (80.2)	1128 (84.4)	0.123
Body mass index (kg/m2), mean (SD)	22.8 (2.9)	22.9 (2.9)	0.899
HBsAg(+)	123 (59.4)	1127 (84.4)	< 0.001
HBeAg(+)	10 (4.8)	236 (17.7)	< 0.001
HBV DNA (+)	50 (24.2)	433 (32.4)	0.017
AST (U/L), median (IQR)	35 (25-55)	40 (29-64)	0.001
ALT (U/L), median (IQR)	34 (24-49)	40 (29-60)	< 0.001
White Blood Cells (109/L), median (IQR)	5.34 (4.18-6.67)	5.37 (4.25-6.63)	0.656
Hemoglobin (g/L), median (IQR)	134 (122-144)	143 (130-153)	< 0.001
Platelets (109/L), median (IQR)	136 (92-185)	130 (92-183)	0.999
Portal hypertension	52 (25.1)	376 (28.1)	0.366

HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; HBV-DNA: Positive indicated by hepatitis B virus DNA > 2000U/mL; IQR: Interquartile range; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 2 Comorbidity in elderly and younger patients n (%)

Comorbidity	Elderly (≥ 65 yr)(n = 207)	Younger (< 65 yr)(n = 1336)	P value
ASA grade (III + IV)	133 (64.3)	95 (7.1)	< 0.001
Charlson index, median (IQR)	2 (1-3)	1 (1-3)	< 0.001
Charlson index > 3	37 (17.9)	114 (8.5)	< 0.001
Comorbidity	122 (58.9)	326 (24.4)	< 0.001
Hypertension	89 (43)	188 (14.1)	< 0.001
Cardiovascular disease	14 (6.8)	28 (2.1)	< 0.001
Pulmonary disease	22 (10.6)	25 (1.9)	< 0.001
Diabetes mellitus	39 (18.8)	78 (5.8)	< 0.001
Renal-related disease	6 (2.9)	21 (1.6)	0.285

Cardiovascular diseases included coronary heart disease, previous coronary revascularization, cerebral arterial occlusive disease, and/or peripheral vascular occlusive disease. Pulmonary diseases indicated chronic obstructive pulmonary disease, asthma, chronic bronchitis and tuberculosis. Renal disease indicated chronic glomerulonephritis, renal insufficiency, hydronephrosis, lithangiuria, and diabetic nephropathy. ASA: American Society of Anesthesiologists category; IQR: Interquartile range.

Table 3 Intraoperative parameters in elderly and younger patients n (%)

Intraoperative parameters	Elderly (≥ 65 yr)(n = 207)	Younger (< 65 yr)(n = 1336)	P value
Major resection	77 (37.2)	497 (37.2)	1.000
Extrahepatic procedures,	38 (18.4)	266 (19.9)	0.601
Inflow occlusion	82 (39.6)	560 (41.9)	0.532
Liver resection with Hooking
with ligation	78 (37.7)	460 (34.4)	0.361
Liver resection with
ultrasonic dissector	129 (62.3)	876 (65.6)	0.361
Laparoscopic hepatectomy	4 (1.9)	15 (1.1)	0.519
Blood loss (mL), mean ± SD	432 ± 327	496 ± 528	0.092
Blood transfusion	38 (18.4)	250 (18.7)	0.903
Anatomic resection	76 (36.7)	481 (36)	0.843

Table 4 Postoperative outcomes in elderly and younger patients n (%)

Postoperative outcomes	Elderly (≥ 65 yr)(n = 207)	Younger (<65 yr)(n = 1336)	P value
Total complications	69 (33.3)	395 (29.6)	0.271
Grade I	18 (8.7)	128 (9.6)	0.686
Grade II	30 (14.5)	163 (12.2)	0.354
Grade III	7 (3.4)	64 (4.8)	0.368
Grade IV	7 (3.4)	24 (1.8)	0.213
Mortality (grade V)	7 (3.4)	16 (1.2)	0.035
Bile Leakage	1 (0.5)	20 (1.5)	0.396
Liver failure	2 (1.0)	25 (1.9)	0.523
Hepatic insufficiency	7 (3.4)	103 (7.7)	0.024
Cardiovascular complications	8 (3.9)	8 (0.6)	< 0.001
Pulmonary complications	19 (9.2)	80 (6.0)	0.081
Infectious complications	14 (6.8)	67 (5.0)	0.294
Bleeding	3 (1.4)	17 (1.3)	1.000
Neurological complications	6 (2.9)	6 (0.4)	0.001
Ascites	7 (3.4)	61 (4.6)	0.440
Gastrointestinal complications	5 (2.4)	32 (2.4)	1.000
ICU stay	76 (36.7)	371 (27.8)	0.008
ICU stay (d), median (IQR)	0 (0-1)	0 (0-1)	0.006
Hospital stay (d), median (IQR)	13 (11-17)	12 (10-15)	< 0.001

Neurological complications indicated confusion and epilepsy. Cardiovascular complications included myocardial infarction, arrhythmia, heart failure and sudden cardiac arrest. Pulmonary complications indicated pulmonary infection, respiratory failure, hydrothorax and hydrothorax. ICU: Intensive care unit; IQR: Interquartile range.