Major Hepatic Resection for Biliary Carcinoma in the Elderly

Michio Kanai, Yuji Nimura, Naokazu Hayakawa, Junichi Kamiya, Satoshi Kondo, Masato Nagino, Masahiko Miyachi, Katsuhiko Uesaka, Shinichi Mizuno

The First Department of Surgery, Nagoya University School of Medicine

We retrospectively evaluated the surgical results of hepatic resection for 22 patients (age≥70 years; the elderly group) with biliary carcinoma and compared their outcomes with those for 84 younger patients (age<70 years; the younger group). Since 1972, hepatic resection has been performed in our department on 199 patients with advanced carcinoma of the gallbladder (93 cases) or the bile duct (106 cases). Of 69 elderly patients with biliary carcinoma, surgical resection was possible in 46 (69.8%) and 41 (56.1%) of them underwent hepatic resection. These rates were similar to those for the younger group (72.6%, 56.7%). Major hepatic resection was performed on 22 elderly patients (right trisegmentectomy 4, extneded right lobectomy 13, right lobectom,y 4, left trisegmentectomy 1). Hyperbilirubinemia above 10 mg/dl and pulmonary complications occurred in 54.5% and 41.0% respectively, of elderly patients undergoing major hepatic resection. These rates were significantly higher than those for younger patients (p<0.05). The hospital mortality rate after major hepatectomy was higher in the elderly group (45.5% vs. 14.6%; p<0.05). The main reasons for hospital mortality were postoperative hyperbilirubinemia and pulmomary complications. However, the hospital mortality rate after major hepatectomy has been decreasing in the elderly by improving perioperative management (1990 or earlier, 58.3%, after 1990, 30%). Morbidity and hospital mortality rates for elderly patients after major hepatectomy were significantly higher than those for younger patients. Prevention of postoperative hyperbilirubinemia and pulmonary complications might improve the outcome after major hepatectomy in the elderly.

Key words
elderly, hepatic resection, hospital mortality

Reprint requests
Michio Kanai The First Department of Surgery, Nagoya University School of Medicine
65 Tsurumaicho, Showa-ku, Nagoya, 466 JAPAN

Accepted
June 12, 1996

To read the PDF file you will need Abobe Reader installed on your computer.