Safety of hepatectomy for elderly patients with hepatocellular carcinoma

Table 1 General surgical risk model in hepatectomy

POSSUM/pPOSSUM	E-PASS	APACHE II score
Physiological parameters
Age	Age	Age
Cardiac history	Severe heart disease	Chronic health point
Respiratory history	Severe pulmonary disease	Temperature
Blood pressure	Diabetes mellitus	Blood pressure
Pulse rate	Performance status	Heart rate
Glasgow Coma scale	ASA score	Respiratory rate
Hemoglobin level		Oxygenation
White cell count		Arterial pH
Urea concentration		Serum sodium
Serum sodium level		Serum potassium
Serum potassium level		Serum creatinine
Electrocardiography		Hematocrit
		White blood cell count
		Glasgow Coma Score
Operative parameters
Operative severity	Blood loss/body weight
Multiple procedures	Operation time
Total blood loss	Extent of skin incision
Peritoneal soiling
Presence of malignancy
Mode of surgery

Table 2 Risk assessment specific for elderly patients undergoing hepatectomy

Simple Risk Score		Nomogram
Physiological parameters	Point		Point
Age		Age
≤ 55	0	18-54	0
55-75	1	55-70	25
> 75	4	≥ 70	54
Sex		Sex
Women	0	Women	0
Men	1	Men	19
Hospital type		Race
Teaching	0	White	0
Nonteaching	3	Non white	21
Charlson comorbidity score		Admission type
0	0	Elective	8
1	3	Urgent/Emergent	32
2	4	Liver primary
≥ 3	8	No	0
		Yes	25
		Hypertension
		Yes	0
		No	61
		Coagulopathy
		No	0
		Yes	100
		Renal failure
		No	0
		Yes	87
		Congestive heart failure
		No	0
		Yes	49
		Cardiac arrhythmias
		No	0
		Yes	47
		Liver disease
		No	0
		Yes	41
		Fluid and electrolyte disorders
		No	0
		Yes	52
		COPD
		No	0
		Yes	17
		Other neurological disorders
		No	0
		Yes	95
Operative paramerters
Procedure type		Procedure type
RFA/enucleation	0	Wedge resection	0
Wedge resection	2	Lobectomy	27
Lobectomy	6

Table 3 Characteristics of elderly hepatocellular carcinoma patients

Ref.	Year	Country	Age	Number of patients		Sex (male) (%)		HBV (%)		HCV (%)		Child-Pugh (B) (%)		Alb (g/dL)		ICG-R15 (%)
				Y	E	Y	E	Y	E	Y	E	Y	E	Y	E	Y	E
Takenaka et al[9]	1994	Japan	70	229	39	81	69	18	5	59	881	24	13	NA	NA	17.4	18.7
Yamamoto et al[62]	1997	Japan	70	40	7	87.5	71.4	10	29	77	71	NA	NA	3.9	4.0	13.6	11.2
Poon et al[10]	1999	China	70	299	31	86	67.71	85.9	51.6	NA	NA	4.7	3.2	4.1	4.1	12.6	14.0
Wu et al[23]	1999	Taiwan	80	239	21	79.5	90.5	58.5	28.61	NA	NA	18.8	23.8	NA	NA	14.2	17.71
Hanazaki et al[11]	2001	Japan	70	283	103	78.4	68.9	23.7	18.4	40.7	55.41	20.1	26.2	3.7	3.7	21.0	21.0
Yeh et al[12]	2004	Taiwan	70	398	34	77.9	79.4	74	25.81	31.8	63.21	23.6	33.3	3.8	3.6	13.3	22.6
Ferrero et al[13]	2005	Italy	70	177	64	81.9	73.4	21.4	10.9	38.9	60.91	22.0	15.6	3.7	3.6	7.2	9.3
Zhou et al[61]	2006	China	65	125	54	85.6	88.9	84.8	59.31	NA	NA	4.8	14.81	NA	NA	NA	NA
Kondo et al[14]	2008	Japan	70	210	109	75.7	72.4	41	11.91	45.7	54.1	6.1	9.2	NA	NA	NA	NA
Kaibori et al[15]	2009	Japan	70	333	155	80.7	76.8	20.1	9.71	693	71.6	9.3	10.3	3.6	3.71	18.7	19.8
Oishi et al[16]	2009	Japan	75	502	64	76	75	24	21	66	70	15.0	8.0	3.8	3.7	17.7	18.7
Huang et al[33]	2009	China	70	268	67	82.8	86.6	88.8	65.71	1.1	7.51	4.1	6.0	4.1	4.0	NA	NA
Mirici-Cappa et al[34]	2010	Italy	70	142	43	81.7	74.4	15	7.1	47.1	57.1	31.3	27.4	NA	NA	NA	NA
Tsujita et al[17]	2010	Japan	75	77	23	67.5	73.9	22	01	65	911	4.0	0.0	4.0	4.0	18.0	19.0
Portolani et al[35]	2011	Italy	70	276	175	82.2	72	30.8	17.11	31.9	45.11	8.3	6.9	NA	NA	NA	NA
Yamada et al[24]	2012	Japan	80	267	11	77	55	27	36	58	56	8.0	22.0	3.7	3.31	17.6	19.4
Tsujita et al[25]	2012	Japan	80	385	23	65.7	65.2	23.1	8.7	70.6	87	31.7	21.7	3.9	4.0	17.0	16.5
Nishikawa et al[19]	2013	Japan	75	206	92	78.1	66.31	17.5	4.31	56.3	66.31	3.9	2.2	4.0	3.8	13.9	14.6
Hirokawa et al[59]	2013	Japan	70	120	100	82	691	NA	NA	50	681	18.0	12.0	NA	NA	14.3	15.1
Ide et al[20]	2013	Japan	75	192	64	82	67	22	13	65	69	13.0	11.0	3.9	3.9	15.7	19.1
Ueno et al[21]	2013	Japan	75	186	66	81	651	20	21	55	56	9.0	9.0	4.0	3.91	13.0	14.01
Taniai et al[64]	2013	Japan	75	353	63	77	62	NA	NA	NA	NA	24.0	11.0	NA	NA	19.1	15.0
Wang et al[63]	2014	China	70	152	56	79	71	98.7	96.5	1.3	3.6	20.0	14.0	3.9	3.9	NA	NA

¹Represents significant difference. Y: Younger patients; E: Elderly patients; Alb: Albumin; ICG: Indocyanine–green retention rate at 15 min; HCV: Hepatitis C virus; HBV: Hepatitis B virus; NA: Not available.

Table 4 Outcome of hepatectomy for elderly hepatocellular carcinoma patients

Ref.	Year	Country	Age	Number of patients		Mortality rate (%)		Morbidity rate (%)		OS at 5 years (%)
				Y	E	Y	E	Y	E	Y	E
Takenaka et al[9]	1994	Japan	70	229	39	1	5	50	51	51.6	75.9
Yamamoto et al[62]	1997	Japan	70	40	7	5	42.91	NA	NA	NA	NA
Poon et al[10]	1999	China	70	299	31	6	10	40	48	51	58
Wu et al[23]	1999	Taiwan	80	239	21	2.1	0	15.5	14.3	59.3	40.9
Hanazaki et al[11]	2001	Japan	70	283	103	6	9.7	23.3	28.2	40	42.2
Yeh et al[12]	2004	Taiwan	70	398	34	7.7	10.5	NA	NA	32.1	39.6
Ferrero et al[13]	2005	Italy	70	177	64	9.6	3.1	42.4	23.41	32.3	48.6
Zhou et al[61]	2006	China	65	125	54	2.4	0	NA	NA	38.6	50.1
Kondo et al[14]	2008	Japan	70	210	109	2.9	3.7	43.8	41.3	NA	NA
Kaibori et al[15]	2009	Japan	70	333	155	4	3	19	18	57.3	54.6
Oishi et al[16]	2009	Japan	75	502	64	1	2	19	22	64	58
Huang et al[33]	2009	China	70	268	67	1.1	1.5	4.5	9	31.4	43.21
Mirici-Cappa et al[34]	2010	Italy	70	142	43	NA	NA	NA	NA	32.4	44.8
Tsujita et al[17]	2010	Japan	75	77	23	1	0	NA	NA	832	702
Portolani et al[35]	2011	Italy	70	276	175	4.3	3.4	16.7	16	NA	NA
Yamada et al[24]	2012	Japan	80	267	11	0	0	3.3 (LF)	0 (LF)	43	26
Tsujita et al[25]	2012	Japan	80	385	23	0.8	4.3	NA	NA	84.8	95.7
Nishikawa et al[19]	2013	Japan	75	206	92	NA	NA	15.5	16.3	64.4	43
Hirokawa et al[59]	2013	Japan	70	120	100	2	2	35	32	64	56
Ide et al[20]	2013	Japan	75	192	64	3.1	3.1	29	33	68	59
Ueno et al[21]	2013	Japan	75	186	66	1	0	19	26	NA	NA
Taniai et al[64]	2013	Japan	75	353	63	2.8	6.3	22.9	30.2	46.6	40.2
Wang et al[63]	2014	China	70	152	56	1.3	3.6	47.4	53.6	NA	NA

¹Represents significant difference;

²Represents OS at 3 years. Y: Younger patients; E: Elderly patients; OS: Overall survival rate; NA: Not available; LF: Liver failure.