The Short- and Long-Term Outcomes in Elderly Patients with Hepatocellular Carcinoma after Curative Surgery: A Case-Controlled Study with Propensity Score Matching

2018 ◽  
Vol 59 (5-6) ◽  
pp. 380-390 ◽  
Author(s):  
Yukiyasu Okamura ◽  
Teiichi Sugiura ◽  
Takaaki Ito ◽  
Yusuke Yamamoto ◽  
Ryo Ashida ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Propensity Matching ◽  
Short And Long Term ◽  
Overall Survival Rates

Background: With aging populations increasing in developed countries, the prevalence of elderly patients with hepatocellular carcinoma (HCC) is expected to rise. The aim of this study was to determine the short- and long-term outcomes of HCC surgery in elderly patients (≥75 years) using propensity score matching. Methods: The study group included 421 patients who underwent hepatectomy as their initial treatment with curative intent. The patients were divided into elderly (n = 111) and non-elderly (n = 310) groups. We applied propensity score matching – taking into consideration patient background, blood examination, and tumor factors – to minimize the effect of potential confounders. We then compared the results before and after the propensity matching. Results: Before propensity matching, the elderly group included significantly more patients with a high American Society of Anesthesiologists physical status (p < 0.001). In addition, they were taking antihypertensive drugs or an anticoagulant (both p < 0.001). The severe postoperative complications and the overall survival rates for these elderly patients were significantly poorer than for the non-elderly patients (p = 0.015 and p = 0.030, respectively). We then chose 70 patients from each group for whom the preoperative confounding factors were balanced and compared the two groups. The factors identified before matching (severe complications and overall survival rates) were no longer relevant, i.e. there were no significant differences between the two groups. Conclusion: Hepatectomy for HCC in elderly patients is justified.

Comparison of short- and long-term outcomes of patients with hepatocellular carcinoma undergoing surgical resection, local ablation, angiological treatment or palliation: Single center results over 35 years

2019 ◽  
Author(s):  
Valtteri Kairaluoma ◽  
Mira Karjalainen ◽  
Juha Saarnio ◽  
Jarmo Niemelä ◽  
Heikki Huhta ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Surgical Resection ◽  
Survival Rates ◽  
Confounding Factors ◽  
Single Center ◽  
Long Term Outcomes ◽  
Local Ablation ◽  
Short And Long Term ◽  
Overall Survival Rates

Abstract Background Hepatocellular carcinoma (HCC) is one leading cause of cancer mortality often presenting at inoperable stage. The aim of this study was to examine and compare surgically resected, locally ablated, angiologically treated and palliatively treated HCC patients’ short- and long-term outcomes in a single center over 35 year period. Methods All HCC diagnosed in Oulu University Hospital between 1983-2018 were identified from hospital records (n=273). Patients underwent hepatic resection (n=49), local ablation (RF, laser ablation or PEI; n=25), angiological treatments (TACE, TAE and SIRT; n=48) or palliative treatment (chemotherapy, best supportive care; n=151). Primary outcomes of the study were postoperative complications within 30 days after the operation, and short- (30- and 90-day) and long-term (1, 3 and 5-year) survival. Results were adjusted with sex, age, comorbidities, cirrhosis, Child-Pugh index points, ASA status, year of operation and stage. Results Surgically resected patients were younger than patients in other groups. Recurrence and local recidives occurred more often in local ablation group and in angiological treatment group (p<0.001). Surgical resection rate was 17.9%. Overall complication rates in surgical resection, local ablation and angiological group were 71.5%, 32.0% and 58.3%, (p<0.001). Major complications in respective groups occurred in 28.6%, 8.0% and 27.1%. Overall survival rates in surgical resection group were at 30 and 90 days, 1-, 3 and 5-years 95.9%, 95.9%, 85.1%, 59.0% and 51.2%. In local ablation group, respective overall survival rates were 100.0%, 100.0%, 86.1%, 43.1% and 18.8%, and in angiological group 95.8%, 93.6%, 56.1%, 26.3% and 6.6%. In cox regression model adjusted for confounding factors, local ablation and angiological treatment were significant risk factors for mortality. Prognosis was poor in palliatively treated patients. Conclusions Based on our study on Northern Finland population, the surgical resection of HCC seems to be the most effective treatment considering long-term survival and tumor recurrence after adjustment for confounding factors.

Effect of surgical start time on short- and long-term outcomes after minimally invasive esophagectomy: a propensity-score matching analysis

2020 ◽  
Author(s):  
Tao Bao ◽  
Xiao-Long Zhao ◽  
Kun-Kun Li ◽  
Ying-Jian Wang ◽  
Wei Guo
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
Start Time ◽  
Short And Long Term ◽  
Mckeown Esophagectomy

Summary There is growing focus on the relationship between surgical start time and postoperative outcomes. However, the extent to which the operation start time affects the surgical and oncological outcomes of patients undergoing esophagectomy has not previously been studied. The purpose of this retrospective study was to investigate the potential effect of surgical start time on the short- and long-term outcomes for patients who underwent thoracoscopic–laparoscopic McKeown esophagectomy. From September 2009 to June 2019, a total of 700 consecutive patients suffering from esophageal cancer underwent thoracoscopic–laparoscopic McKeown esophagectomy in the Department of Thoracic Surgery at Daping Hospital. Among these patients, 166 esophagectomies were performed on the same day and were classified as the first- or second-start group. Patients in the first-start group were more likely to be older than those in the second-start group: (64.73 vs. 61.28, P = 0.002). In addition, patients with diabetes mellitus were more likely to be first-start cases (8.4 vs. 1.2%). After propensity score matching (52 matched patients in first-start cases and 52 matched patients in second-start cases), these findings were no longer statistically significant. There was no difference in the incidence rate of peri- or postoperative adverse events between the first- and second-start groups. The disease-specific survival rates and disease-free survival rates were comparable between the two groups (P = 0.236 and 0.292, respectively). On the basis of the present results, a later start time does not negatively affect the short- or long-term outcomes of patients undergoing minimally invasive McKeown esophagectomy.

scholarly journals Age Is No Longer a Limit: Two Cases of Hepatectomy in Patients Over 90 Years Old

2015 ◽  
Vol 9 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Shugo Uwatoko ◽  
Kentaroh Yamamoto ◽  
Takamitsu Sasaki ◽  
Daisuke Fukumori ◽  
Hirotsune Igimi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Malignant Tumor ◽  
Poor Prognosis ◽  
Major Hepatectomy ◽  
Long Term Outcomes ◽  
Younger Patients ◽  
The World ◽  
Short And Long Term

Hepatocellular carcinoma (HCC) is a common malignant tumor with poor prognosis. The age of patients affected by HCC is considered to be increasing, and several studies have reported significantly higher rates of morbidity and mortality after hepatectomy for HCC in elderly patients. However, other studies have reported that the short- and long-term outcomes of surgery for HCC in elderly patients are similar to those in younger patients. Whether the indications for hepatic resection in elderly patients resemble those in younger patients has thus been questioned. We describe two cases of patients over 90 years old who underwent major hepatectomy for HCC, representing the oldest patients in the world to have done so.

Hepatectomy Provides Good Long-Term Outcomes for Hepatocellular Carcinoma Patients With Portal Hypertension: A Propensity Score Matching Analysis

2020 ◽  
Author(s):  
Xiwen Wu ◽  
Wei Chen ◽  
Bin Chen ◽  
Wenxuan Xie ◽  
Shutong Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Venous Invasion ◽  
Long Term Outcomes ◽  
Propensity Score Matching Analysis ◽  
Initial Hepatectomy ◽  
Baseline Characteristics

Abstract Background: The role of hepatectomy in hepatocellular carcinoma (HCC) with portal hypertension (PH) remains controversial. This study aimed to evaluate the effect of hepatectomy on overall survival (OS) of HCC patients with PH.Methods: A total of 1651 HCC initially treated with hepatectomy were retrospectively reviewed and divided into PH group (n=157) or non-PH group (n=1494). Propensity score matching (PSM) was conducted to match the baseline characteristics of the PH group and non-PH group. Results: The PH group presented a similar OS (p=0.29) and recurrence free survival (RFS) (p=0.83) compared with non-PH group after initial hepatectomy before PSM. After PSM processing, the baseline characteristics were highly comparable for both groups (133 patients in each group). The PH group also presented a similar OS (p=0.81) and RFS (p=0.65) compared with non-PH group after initial hepatectomy. After PSM, multivariate analysis identified tumor size (>5 cm) (p=0.02), macro-venous invasion (p < 0.001), AST (>37 U/L) (p =0.008) as independent risk factors for OS.Conclusions: Hepatectomy provides good long-term outcomes for HCC patients with PH. PH should not be regarded as a contraindication for hepatectomy in HCC patients.

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