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Surgical resection for hepatocellular carcinoma: clinical outcomes and safety in elderly patients

Nishikawa, Hirokia; Arimoto, Akirab; Wakasa, Tomokoc; Kita, Ryuichia; Kimura, Torua; Osaki, Yukioa

European Journal of Gastroenterology & Hepatology: August 2013 - Volume 25 - Issue 8 - p 912–919
doi: 10.1097/MEG.0b013e32835fa668
Original Articles: Liver Cancer

Objectives The aim of this study was to compare the clinical outcomes and safety of surgical resection for hepatocellular carcinoma between patients older than 75 years of age (elderly group) and those younger than 75 years (control group).

Methods A total of 92 patients were included in the elderly group and 206 patients were included in the control group. Clinical outcomes including overall survival, recurrence-free survival, and safety were compared between these two groups after initial surgery.

Results The mean (±SD) observation periods were 2.5±1.8 years in the elderly group and 3.1±2.2 years in the control group. The 1, 3, and 5-year overall survival rates after surgery were 90.0, 73.3, and 43.0%, respectively, in the elderly group and 91.0, 77.5, and 64.4%, respectively, in the control group (P=0.188). The corresponding recurrence-free survival rates were 66.3, 38.8, and 26.2%, respectively, in the elderly group and 66.3, 38.8, and 22.2%, respectively, in the control group (P=0.634). Multivariate analysis identified a total bilirubin level greater than 1.0 mg/dl (P=0.003), a serum albumin level greater than 4.0 g/dl (P=0.005), an α-fetoprotein level greater than 100 ng/ml (P<0.001), and microvascular invasion (P<0.001) as significant factors linked to overall survival, and tumor number (P=0.014) and microvascular invasion (P=0.008) were significant factors associated with recurrence-free survival. There was no significant difference between the two groups in terms of surgery-related serious adverse events (P>0.999).

Conclusion Surgical resection appears to be a safe and feasible procedure for the treatment of hepatocellular carcinoma in elderly patients.

Departments of aGastroenterology and Hepatology


cPathology, Osaka Red Cross Hospital, Osaka, Japan

Correspondence to Hiroki Nishikawa, MD, Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka 543-0027, Japan Tel: +81 6 6774 5111; fax: +81 6 6774 5131; e-mail:

Received November 16, 2012

Accepted January 31, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins