Indication and Limitation of Major Hepatectomy for Hepatocellular Carcinoma in the Aged Patients

Shoji Kubo, Hiroaki Kinoshita, Kazuhiro Hirohashi, Hiromu Tanaka, Tadashi Tsukamoto, Taichi Shuto, Toyokazu Okuda, Akishige Kanazawa, Shinichi Mikami, Chikaharu Sakata

Second Department of Surgery, Osaka City University Medical School

Three hundred ninety-three patients who underwent liver resection for hepatocellular carcinoma were divided into two groups according to age; an aged group, 70 years old or more (n=34) and a non-aged group, less than 70 years old (=357). There were no significant differences in the results of a 15-min indocyanine green retension test, clinical stage, stage, operative methods, and clinicopathological findings including the diameter, the grade of differentiation of the main tumor and the incidence of portal thrombi and intrahepatic metastases between the two groups. The rate of hospital death in the non-aged group was 4% and that in the aged group was 15%. For the patients who underwent bi-segmentectomy, the hospital death rate in the non-aged group was 2% and that in the aged group was 57%. In three patients who were 75 years old or more and who underwent bisegmentectomy or segmentectomy, the rate was 100%. There were no differences in the survival rate and tumor-free survival rate between the two groups. In the patients who were 65 years old or more and who underwent bisegmentectomy, the rate of operative and hospital deaths among the patients who underwent percutaneous transhepatic portal vein embolization (PTPE) preoperatively was 14%. The rate was 36% for the patients without PTPE. Major hepatectomy is risky for aged patients. Preoperative PTPE is useful for improvement of the outcome after major hepatectomy for aged patients.

Key words
hepatocellular carcinoma in aged patients, preoperative portal vein embolization, major hepatectomy, operative death

Reprint requests
Shoji Kubo Second Department of Surgery, Osaka City University Medical School
1-5-7 Asahimachi, Abeno-ku, Osaka, 545 JAPAN

Accepted
June 12, 1996

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