2023 年 14 巻 2 号 p. 81-92
Background: In an aging population, hepatectomy, a highly invasive surgical procedure, is increasingly being performed on individuals aged 80 and above in Japan. However, there is a need to evaluate the effectiveness of the eligibility criteria used for patient selection and assess the surgical outcomes and risks associated with the procedure.
Methods: This retrospective cohort study included 104 patients aged 80 years or older who met the lesion localization criteria for hepatectomy. The patients were divided into the hepatectomy group and the non-surgical group. Survival rates and postoperative complications were evaluated using Kaplan-Meier analysis and multivariate regression models.
Results: The eligibility criteria effectively identified patients who were not suitable for hepatectomy, as evidenced by the survival outcomes of the non-surgery group. The hepatectomy group had a median overall survival of 59.3 months. Postoperative complications were observed in 21.4% of hepatectomy cases, with a mortality rate of 1.19%. Factors such as prealbumin and indocyanine green retention rate at 15 min were found to influence postoperative prognosis. Intraoperative bleeding volume was identified as a significant predictor of complications. Female patients had a lower rate of postoperative complications.
Conclusion: The eligibility criteria for hepatectomy developed in this study were effective in identifying suitable candidates among super elderly patients aged 80 and above. Analysis of survival outcomes and factors affecting postoperative prognosis and complications provided valuable insights into surgical management in this specific patient population. Meticulous surgical technique and effective bleeding control strategies are crucial in minimizing the risk of complications. Further research and interventions focused on optimizing management of intraoperative bleeding may contribute to improved outcomes in hepatectomy patients. It is important to consider the limitations of this single-center study and conduct larger multi-center studies for generalizability.
