The impact of age and ageing on hepatocarcinoma surgery: Short- and long-term outcomes in a multicentre propensity-matched cohort.

ABSTRACT

BACKGROUND: Management of malignancy in elderly patients is challenging. We aimed to assess the impact of age and ageing on overall survival (OS), recurrence-free survival (RFS), tumour-specific survival (TSS) and potential years of life lost (PYLL) after surgery for hepatocarcinoma (HCC). METHODS: Consecutive patients treated for HCC between 2005 and 2015 were evaluated. Patients were divided according to age-decade. Afterwards, elderly patients (≥75 years) were compared with patients < 75 years. A 11 propensity matching was used to reduce the risk of bias. Survival was estimated by Kaplan-Meier method and Cox regression analysis. RESULTS: Four hundred and thirty-nine patients were stratified group 1 (age ≤ 55, n = 72), group 2 (age 56-65, n = 133), group 3 (age 66-74, n = 141) and group 4 (age ≥ 75, n = 93). Group 1 had the highest median PYLL (27.6, IQR 24.6-32.5) while group 4 the lowest (2.0, IQR 0-9.6; P < 0.001). Comparing elderly vs younger, there were no significant differences in terms of OS (P = 0.054), TSS (P = 0.321) and RFS (P = 0.240). Ageing was the only variable associated with post-operative complications (OR 2.51; 95% CI 1.23-5.13; P = 0.025) and liver-related morbidity was an independent predictor of OS. (HR 2.49, 95% CI 1.34-4.64, P = 0.004). CONCLUSION: Ageing per se is not an absolute contraindication for liver resection, given the acceptable oncologic long-term prognosis, but the worse short-term outcomes in the elderly should induce an accurate patient selection.