The Survival Paradox of Elderly Patients After Major Liver Resections

The objective of this study is to assess the outcome of liver resections in the elderly in a matched control analysis. From a prospective single center database of 628 patients, 132 patients were aged 60 years or over and underwent a primary major liver resection. Of these patients, 93 could be matched one-to-one with a control patient, aged less than 60 years, with the same diagnosis and the same type of liver resection. The mean age difference was 16.7 years. Patients over 60 years of age had a significantly higher American Society of Anaesthesiologists (ASA) grade. All other demographics and operative characteristics were not different. In-hospital mortality and morbidity were higher in the patients over 60 years of age (11% versus 2%, p=0.017 and 47% versus 31%, p=0.024). One-, 3-, and 5-year survival rates in the patients over 60 years of age were 81%, 58%, and 42%, respectively, compared to 90%, 59%, and 42% in the control patients (p=0.558). Unified model Cox regression analysis showed that resection margin status (hazard ratio 2.51) and ASA grade (hazard ratio 2.26), and not age, were determining factors for survival. This finding underlines the important fact that in patient selection for major liver resections, ASA grade is more important than patient age

Secundaire toeganschirurgie voor hemodialyse en chemotherapie.

De samenstelling van deze serie uit verschillende types A-V verbindingen weerspiegelt het feit, dat in de literatuur nog geen eenduidend oordeel is te vinden over de verschillende types A-V verbindingen die kunnen worden toegepast bij chemotherapiepatienten. ... Zie: Samenvattin

Liver transplantation in patients with hepatocellular carcinoma

Liver transplantation has a definitive place in the treatment of patients with hepatocellular carcinoma (HCC) in a cirrhotic liver. Patients with a tumor load within the Milan criteria have excellent survival comparable to survival in patients with benign indications. When tumor load exceeds the Milan criteria survival decreases. Staging of patients with HCC in a cirrhotic liver is deficient due to the. restrictions of the current imaging modalities. The exact place of tumor controlling therapies during the waiting time for transplantation is not yet clear. No evidence of sufficient level is available as to the efficacy of pre-, per- or postoperative chemotherapy. Promising new drugs are currently tested. This counts also for the use of new immunosuppressant with concomitant tumor suppressive capabilities