Hepatic resection for malignant liver tumours in the elderly: a systematic review and meta-analysis

• Published in: ANZ journal of surgery Vol. 85; no. 11; pp. 815 - 822
• Main Authors: Phan, Kevin, An, Vincent Vinh Gia, Ha, Hakeem, Phan, Steven, Lam, Vincent, Pleass, Henry
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-11-2015
• Subjects: Age Factors; Aged; Cancer surgery; Disease-Free Survival; elderly; hepatectomy; Hepatectomy - mortality; Humans; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - surgery; liver resection; malignant liver disease; Meta-analysis; Models, Statistical; Mortality; Surgical outcomes; Systematic review; Tumors; hepatectomy; liver resection; malignant liver disease; elderly
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.13211

Background
The number of elderly patients undergoing hepatic resection for surgical treatment of benign and malignant cancers is increasing. However, there is limited clinical data on the complications and long‐term survival rates associated with liver surgery in the elderly patients (≥70 years) versus younger patients for malignant liver conditions.
Methods
Six electronic databases were searched for original published studies comparing elderly (≥70) versus younger (<70) cohorts for malignant liver tumours. Data were extracted and analysed according to predefined clinical endpoints.
Results
Twenty‐seven comparative studies were identified, including 4769 elderly patients versus 15 855 younger patients (n = 20 624). There was significantly higher 30‐day mortality in the elderly colorectal liver metastasis group (P < 0.00002) and significant difference between elderly and young in terms of overall survival (hazard ration (HR), 1.10; P = 0.02). However, there was no difference in disease‐free survival (HR, 1.05; P = 0.27). Post‐operative pneumonia, renal failure and infection were more frequent in the elderly group.
Conclusions
Liver resection for malignant hepatic tumours in the elderly is associated with a greater 30‐day mortality and overall mortality when compared with younger cohorts, but similar disease‐free survival. Length of stay and transfusions were not significantly different while pneumonia, renal failure and infections were more frequent in the elderly group.