• Masaki Kaibori, Kengo Yoshii, Isao Yokota, Kiyoshi Hasegawa, Fumio Nagashima, Shoji Kubo, Masanori Kon, Namiki Izumi, Masumi Kadoya, Masatoshi Kudo, Takashi Kumada, Michiie Sakamoto, Osamu Nakashima, Yutaka Matsuyama, Tadatoshi Takayama, Norihiro Kokudo, and Liver Cancer Study Group of Japan.
• Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
• Ann. Surg. 2019 Apr 1; 269 (4): 692-699.

ObjectiveThe impact of age on survival after hepatic resection for hepatocellular carcinoma (HCC) has not been thoroughly examined. We reviewed the data of a nationwide follow-up survey to determine the outcomes of hepatectomy for HCC in elderly patients.BackgroundManagement of malignant diseases in elderly patients has become a global clinical issue because of the increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for liver surgery.MethodsIn all, 12,587 patients with HCC who underwent curative hepatic resection were included in this cohort study and classified according to age group [40-59 years (n = 2991), 60-74 years (n = 7576,), and ≥75 years (n = 2020)]. Clinicopathological features, long-term survival, and cumulative incidences of death after hepatic resection were compared among the groups. The cause-specific subdistribution hazard ratios for 3 types of death depending on age were also estimated.ResultsPreoperative liver function tests showed that the prothrombin activity and platelet count were higher in the ≥75-year age group than in the other age groups. The overall survival was significantly lower in the elderly than younger patients. However, recurrence-free survival was almost identical among the 3 groups. The cumulative incidence of HCC-related or liver-related death was almost identical among the 3 groups; however, the cumulative incidence of other causes of death was significantly different. The 60-year subdistribution hazard ratio for other causes of death increased remarkably with increasing age.ConclusionsElderly patients in this nationwide survey had significantly worse overall survival after hepatectomy than middle-aged and young patients. The cumulative incidence of other causes of death in elderly patients was significantly different from that of HCC-related or liver-related death among the 3 groups.

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