Iswanto Sucandy1,2, Susannah Cheek3,4, Allan Tsung3,4, J Wallis Marsh3,4, David A Geller3,4. 1. University of Pittsburgh Medical Center/UPMC Liver Cancer Center, 3459 Fifth Avenue, UPMC Montefiore, 7-South, Pittsburgh, PA, 15213-2582, USA. iswanto_sucandy@yahoo.com. 2. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. iswanto_sucandy@yahoo.com. 3. University of Pittsburgh Medical Center/UPMC Liver Cancer Center, 3459 Fifth Avenue, UPMC Montefiore, 7-South, Pittsburgh, PA, 15213-2582, USA. 4. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract
BACKGROUND: As minimally invasive technique becomes more popular, an increasing number of elderly patients were considered for minimally invasive liver resection (MILR). Limited physiologic reserve remains a major concern, which frequently leads surgeons to recommend nonresectional alternatives. We sought to evaluate complications and outcomes of elderly patients undergoing MILR. METHODS: Eight hundred and thirty-one patients who underwent MILR were classified into groups A, B, and C based on age [(< 70, n = 629), (70-79, n = 148), (≥ 80, n = 54) years old, respectively]. RESULTS: Gender distribution, BMI, and cirrhotic status were comparable among all groups. Groups B and C had higher MELD (p = 0.047) and ASA (p = 0.001) scores. Operative time (170, 157, 152 min; p = 0.64) and estimated blood loss (145, 130, 145 ml; p = 0.95) were statistically equal. Overall postoperative complications were greater in groups B and C (12.9 and 9.3 vs. 6.5%, respectively). Complications in group C were all minor. Clavien-Dindo grade III-IV complications were higher in group B when compared to group A (6.8 vs. 2.7%, p = 0.43). There was no significant difference in cardiopulmonary complications, thromboembolic events, ICU admissions, and transfusion rates seen in groups B and C when compared to group A. Duration of hospital stay was statistically longer in groups B and C (3.6, 3.5 vs. 2.5 days, p = 0.0012). 30- and 90-day mortality rates were comparable among the groups, irrespective of age. CONCLUSIONS: In spite of greater preoperative comorbidities and ASA score, there was no significant increase in postoperative morbidity after minimally invasive liver resection in patients ≥ 70 years of age.
BACKGROUND: As minimally invasive technique becomes more popular, an increasing number of elderly patients were considered for minimally invasive liver resection (MILR). Limited physiologic reserve remains a major concern, which frequently leads surgeons to recommend nonresectional alternatives. We sought to evaluate complications and outcomes of elderly patients undergoing MILR. METHODS: Eight hundred and thirty-one patients who underwent MILR were classified into groups A, B, and C based on age [(< 70, n = 629), (70-79, n = 148), (≥ 80, n = 54) years old, respectively]. RESULTS: Gender distribution, BMI, and cirrhotic status were comparable among all groups. Groups B and C had higher MELD (p = 0.047) and ASA (p = 0.001) scores. Operative time (170, 157, 152 min; p = 0.64) and estimated blood loss (145, 130, 145 ml; p = 0.95) were statistically equal. Overall postoperative complications were greater in groups B and C (12.9 and 9.3 vs. 6.5%, respectively). Complications in group C were all minor. Clavien-Dindo grade III-IV complications were higher in group B when compared to group A (6.8 vs. 2.7%, p = 0.43). There was no significant difference in cardiopulmonary complications, thromboembolic events, ICU admissions, and transfusion rates seen in groups B and C when compared to group A. Duration of hospital stay was statistically longer in groups B and C (3.6, 3.5 vs. 2.5 days, p = 0.0012). 30- and 90-day mortality rates were comparable among the groups, irrespective of age. CONCLUSIONS: In spite of greater preoperative comorbidities and ASA score, there was no significant increase in postoperative morbidity after minimally invasive liver resection in patients ≥ 70 years of age.
Authors: Srinevas K Reddy; Andrew S Barbas; Ryan S Turley; T Clark Gamblin; David A Geller; J Wallis Marsh; Allan Tsung; Bryan M Clary; Sandhya Lagoo-Deenadayalan Journal: J Am Coll Surg Date: 2011-03-23 Impact factor: 6.113
Authors: Ibrahim Dagher; Brice Gayet; Dimitrios Tzanis; Hadrien Tranchart; David Fuks; Olivier Soubrane; Ho-Seong Han; Ki-Hun Kim; Daniel Cherqui; Nicholas O'Rourke; Roberto I Troisi; Luca Aldrighetti; Edwin Bjorn; Mohammed Abu Hilal; Giulio Belli; Hironori Kaneko; William R Jarnagin; Charles Lin; Juan Pekolj; Joseph F Buell; Go Wakabayashi Journal: J Hepatobiliary Pancreat Sci Date: 2014-08-06 Impact factor: 7.027
Authors: Krishna V Menon; Ahmed Al-Mukhtar; Amer Aldouri; Rajendra K Prasad; Peter A Lodge; Giles J Toogood Journal: J Am Coll Surg Date: 2006-09-26 Impact factor: 6.113
Authors: R Adam; A Frilling; D Elias; C Laurent; E Ramos; L Capussotti; G J Poston; D A Wicherts; R J de Haas Journal: Br J Surg Date: 2010-03 Impact factor: 6.939
Authors: Kota Sahara; Anghela Z Paredes; Diamantis I Tsilimigras; J Madison Hyer; Katiuscha Merath; Lu Wu; Rittal Mehta; Eliza W Beal; Susan White; Itaru Endo; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2019-02-04 Impact factor: 3.452