Published online Dec 27, 2023. doi: 10.4254/wjh.v15.i12.1307
Peer-review started: July 28, 2023
First decision: September 14, 2023
Revised: October 25, 2023
Accepted: December 4, 2023
Article in press: December 4, 2023
Published online: December 27, 2023
Processing time: 150 Days and 0.9 Hours
Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality.
To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score.
A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm.
Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles.
This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.
Core Tip: To support the decision-making process in elderly patient with resectable hepatocellular carcinoma (HCC) and understand who can benefit from surgical treatment in terms of postoperative mortality, we analyzed data from 11 hepato-biliary centers during a 10-years period. A multivariate analysis was performed to find variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90‐ and 180‐d mortality. The evaluation of elderly patients who underwent liver resection for HCC need to be supported by any form of possible analysis of risk.