HPB
Eric Luo
Medical Student
University of South Florida Morsani College of Medicine, United States
Disclosure: Disclosure information not submitted.
Age is a driving risk factor for liver malignancies. Understanding the benefit of hepatectomy in the geriatric population is essential as it relates to postoperative recovery and receipt of adjuvant chemotherapy. We sought to evaluate postoperative outcomes following hepatectomy in older adults and examine their ability to successfully return to intended oncologic therapy (RIOT).
Methods:
A retrospective cohort study including consecutive patients undergoing hepatectomy for liver malignancies at a cancer center was performed (2015-2021). Patients were categorized based on age into: young (< 70 years) and geriatric (≥70 years) cohorts. The primary outcome was Textbook Outcome (TO) defined as: no 90-day mortality, readmission or Clavien-Dindo III-IV complications, and no prolonged LOS. RIOT was the secondary outcome, measured in days. Multivariate regression models and time-to-event analysis were performed to examine the association of age with outcomes.
Results:
567 patients were included in the study; 163 (29%) in the geriatric cohort. Overall TO occurred in 67% of patients. Geriatric patients experienced a non-statistically significant lower rate of TO (62% vs. 69%; p=0.11), with differences mainly driven by higher rates of readmission (14.7% vs. 9.7%) and prolonged LOS (26% vs. 22%) in the geriatric cohort (Figure). On multivariate analysis, increasing age (OR 1.03 [95%CI 1.01-1.05]; p=0.001) and age≥80 years (OR 2.63 [1.12-6.20]; p=0.02) were each associated with increased risk of non-TO. Despite this association, there was no difference in RIOT between the young and geriatric groups (median 54 days vs. 59 days, p=0.11), with RIOT driven by the occurrence of TO (TO: median 50 days vs. non-TO: 69 days; p=0.0002).
Conclusions:
Increasing age is associated with a higher risk of non-TO following hepatectomy, due to differences in postoperative recovery. However this was not associated with worse RIOT patterns in geriatric patients. These data support the use of a similar oncologic and surgical approach for young and well-selected geriatric patients, while also emphasizing the need to optimize postoperative recovery in older adults.