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Does an extreme age (≥80 years) affect outcomes in patients after liver cancer surgery? A meta‐analysis
Author(s) -
Wei Fangqiang
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14676
Subject(s) - medicine , contraindication , hazard ratio , confidence interval , relative risk , cancer , surgery , pathology , alternative medicine
Background Increasing global life expectancy has resulted in a greater demand for cancer surgery in aged patients. However, whether extreme age causes poorer clinical outcomes remains unclear. This meta‐analysis aimed to evaluate the impact of extreme age (≥80 years) on outcomes in patients after liver cancer surgery. Methods A systematic search was performed to enrol relevant studies. Data were analysed using fixed‐effects or random‐effects models. Eight retrospective studies involving 253 participants older than 80 years were included. Results Compared with younger patients, patients of extreme age (≥80 years) who had undergone curative liver cancer surgery experienced less operating time and blood loss (both P < 0.0001); a larger size (weighted mean difference = 0.48 cm, 95% confidence interval (CI) 0.08–0.87 cm; P = 0.02) and more advanced stage of hepatocellular carcinoma (risk ratio (RR) = 1.20, 95% CI 1.04–1.39; P = 0.01); a higher overall morbidity (RR = 1.24, 95% CI 1.05–1.47; P = 0.01); and more post‐operative ileus (POI) (RR = 3.45, 95% CI 1.03–11.56; P = 0.04), delirium (RR = 3.04, 95% CI 1.36–6.78; P = 0.007) and cardiovascular events (RR = 6.17, 95% CI 2.79–13.60; P < 0.00001). No significant difference was noted in overall (hazard ratio (HR) = 1.15, 95% CI 0.87–1.53; P = 0.32) or disease‐free (HR = 0.96, 95% CI 0.75–1.24; P = 0.77) survival. Conclusion Although an extreme age may not be a contraindication for undertaking liver cancer surgery, it may cause more morbidity. Perioperative intervention should be considered for prevention and early treatment of POI, delirium and cardiovascular events.