Surgical treatment of hepatocellular carcinoma in elderly cirrhotic patients: personal experience

BACKGROUND: Due to the longer life expectancy of the world's population, the number of elderly cirrhotic patients undergoing surgery for hepatocellular carcinoma (HCC) is increasing. Our study evaluates the benefits of hepatic resections for HCC in cirrhotic patients aged over 65, analysing the early and long-term surgical results. PATIENTS AND METHODS: We retrospectively considered a series of 46 patients receiving hepatic resection for HCC. The clinicopathological data and surgical outcome of 14 (30.4%) patients aged 65 or older (group I) were evaluated and compared to the 32 (69.6%) younger than 65 (group II). RESULTS: No operative mortality was recorded in either group. The hospital mortality rate was 7.1% (1 out of 14) in group I and 9.4% (3 out of 32) in group II (p = 1.00). Hospital morbidity did not differ significantly in the two groups (21.4% vs 34.4%; p = 0.50). At follow-up (median 34 months, interquartile range: 12-63) 3 patients from group I (21.4%) and 16 patients from group II (50%) experienced tumor recurrence (p = 0.14). The five-year disease-free survival rate for group I and group II was 71.4% vs 28.2%, respectively (p = 0.05). The overall 5-year survival rate for group I and group II was, respectively, 77.4% vs 41.8%, (p = 0.3). CONCLUSION: Elderly cirrhotic patients with HCC can benefit from hepatic resection as well as younger patients; age by itself should not be considered a contraindication to surgery.