Peri-operative score for elderly patients with resectable hepatocellular carcinoma

ARTICLE HIGHLIGHTS

Research background

Liver resection represented one of the mainstay treatment for hepatocellular carcinoma (HCC). The approach of liver disease in elderly population needed of an accurate stratification of patients at risk, with the involvement of multidisciplinary preoperative assessment.

Research motivation

Liver resection is burdened by a variable rate of postoperative morbidity and mortality. Elderly patients represented more often the major rate of patients who underwent liver resection for HCC. This aspect makes mandatory an accurate preoperative assessment and a specific evaluation of potential postoperative risk.

Research objectives

The aim of our study was to analyze a population of elderly patients who underwent liver resection for HCC, to investigate the possible presence of risk predictors of postoperative mortality at 90 and 180 d.

Research methods

Associations between baseline pre-operative variables with six-month mortality were evaluated using a unit-variate Cox proportional-hazards model. A score point system was derived from the multi-variable Cox proportional-hazards model.

Research results

The American Society of Anesthesiology (ASA) score, Mayo end stage liver disease score, the presence of comorbidities > 2 and the size of the biggest lesion are included in the stratification of the score. Combining the four variables we obtained different profiles of patients with a different preoperative risk at 6 mo: Low-risk < 5%, mid-risk 5%-10% and high-risk class > 10%.

Research conclusions

This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.

Research perspectives

Randomized controlled studies are needed to better explore these results.