Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2023; 15(12): 1307-1314
Published online Dec 27, 2023. doi: 10.4254/wjh.v15.i12.1307
Peri-operative score for elderly patients with resectable hepatocellular carcinoma
Maria Conticchio, Riccardo Inchingolo, Antonella Delvecchio, Francesca Ratti, Maximiliano Gelli, Massimiliano Ferdinando Anelli, Alexis Laurent, Giulio Cesare Vitali, Paolo Magistri, Giacomo Assirati, Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Tullio Piardi, Fabrizio di Benedetto, Nicola de'Angelis, Javier Briceño, Antonio Rampoldi, Renè Adam, Daniel Cherqui, Luca Antonio Aldrighetti, Riccardo Memeo
Maria Conticchio, Antonella Delvecchio, Riccardo Memeo, Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Acquaviva Delle Fonti 70021, Italy
Riccardo Inchingolo, Interventional Radiology Unit, Department of Radiology, “F. Miulli” Regional General Hospital, Acquaviva Delle Fonti 75100, Italy
Francesca Ratti, Luca Antonio Aldrighetti, Hepatobiliary Surgery Division, IRCSS San Raffaele Scientific Institute, Milan 20132, Italy
Francesca Ratti, Luca Antonio Aldrighetti, Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, Milan 20132, Italy
Maximiliano Gelli, Département de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Paris 94800, France
Massimiliano Ferdinando Anelli, Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Cordoba 14004, Spain
Alexis Laurent, Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Créteil 94000, France
Giulio Cesare Vitali, Service of Abdominal Surgery, Poliambulanza Foundation, Brescia 25124, Italy
Paolo Magistri, Giacomo Assirati, Fabrizio di Benedetto, Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
Emanuele Felli, Taiga Wakabayashi, Department of Surgery, Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg 67000, France
Patrick Pessaux, Service de Chirurgie Viscérale et Digestive, Nouvel Hôpital Civil, Unité INSERM U1110, Strasbourg 67000, France
Tullio Piardi, Department of Surgery, Hôpital Robert Debré, Reims 51092, France
Nicola de'Angelis, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, Paris 94000, France
Javier Briceño, Unit of Hepatobiliary Surgery and Liver Transplantation, Hospital University Reina Sofía, Cordoba 14004, Spain
Antonio Rampoldi, Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
Renè Adam, Daniel Cherqui, Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Paris 94000, France
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Institutional review board statement: This study does not require approval from the hospital ethics committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Riccardo Inchingolo, MD, Director, Doctor, Interventional Radiology Unit, Department of Radiology, “F. Miulli” Regional General Hospital, Strada Per Santeramo, Acquaviva Delle Fonti 75100, Italy. riccardoin@hotmail.it
Received: July 28, 2023
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
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.

Keywords: Hepatocellular carcinoma; Score; Laparoscopy; Surgical resection; Elderly patients; Multivariate analysis

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.