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Aim: Health-status of elderly patients with hepatocellular carcinoma (HCC) may limit surgical approach; other options are thus auspicable., Methods: The authors reviewed 98 selected patients, aged 65 to 90 years, with 149 HCC treated between 2002 and 2011. According to the extent of malignancy, health status and treatment, patients were divided into 3 groups. Sixty-one, submitted to major and minor curative resections, were in group A and B while group C included 37 patients, unsuitable for high-risk procedures and percutaneous ablation, submitted to intraoperative-radiofrequency ablation (IRFA) alone or combined with minor resections. Assessment of safety and therapeutic efficacy of this managment was evaluated., Results: A postoperative mortality rate of 1,02% and an overall survival rate at 5 years of 62.3% were observed. Indeeed matched post-operative morbidity and mortality rates of A, B, C groups were 45%, 8%, 16.21% (p < 0.004) and 9 %, 0%, 0% (p= 0.112 ) respectively. 3 years overall-survival was not statistically different (p= 0.585). However 5 years survival rate and disease-free-survival rate were significantly higher in patients of group A and B (p= 0.003; p< 0.001)., Conclusion: Treatment strategies to minimize treatment-related morbidity and mortality have resulted satisfactory for early and late outcomes of an heterogeneous group of elderly patients with HCC.

Background: The most important aims of the treatment of CLC are long-term relief of symptoms and elimination of cysts. Treatment of choice is yet debated., Methods: Data of patients treated for CLC during a 35-years experience were retrospectively analyzed. Variables analyzed were: age, sex, hepatic cyst location, cyst diameter, symptoms, surgical procedure, short and long-term outcomes., Results: We examined 49 consecutive patients treated for CLC (mean follow-up, 76 months). The study was divided into two periods: 1975-1999 and 2000-2010. Procedures performed in the first period were needle aspiration and sclerotherapy (n= 6), hepatic resections (9), cystojejunostomy (4), open unroofing (10), and laparoscopic unroofing (8). Omentopexy within the residual cystic cavity was associated with seven open and two laparoscopic unroofing cases. Rates of morbidity and recurrence were 23.5% and 44.1%, respectively. One patient died in the peri-operative period. Procedures performed in the second period were open unroofing (9), laparoscopic unroofing (5), and hepatic resection (1). Omentopexy was associated with all open procedures and two laparoscopic procedures. Overall morbidity in this group was 16.6%, and recurrence occurred in one patient (6.7%)., Conclusions: Cyst unroofing and omentopexy is a safe and highly effective procedure for the treatment of CLC. Laparoscopy is confirmed as the procedure of choice except for cases in which the cysts are in the posterior right liver, where a wide mobilization of the liver is necessary.

Background: The aim of this study was to evaluate the results of conservative and radical treatment of liver hydatid disease., Methods: Records of patients who underwent surgery for liver hydatid disease between 1980 and 2005 were reviewed. Outcomes measured were operative morbidity and mortality, hospital stay, and recurrence., Results: Two hundred fourteen patients underwent conservative treatment (external drainage, marsupialization, omentoplasty), and 240 had radical surgery (hepatic resection, cystopericystectomy). Operative morbidity was 79.9% and 16.2% for conservative and radical procedures, respectively (P < .001). Operative mortality was 6.5% for conservative procedures and 9.2% for radical procedures (P = .3). The recurrence rate was 30.4% in patients having conservative surgery and 1.2% in patients undergoing radical surgery (P < .001). No recurrences occurred in patients with clear cysts after conservative surgery., Conclusions: Cystopericystectomy was a safe and effective procedure that achieved excellent immediate and long-term results. Hepatic resection should be considered only in exceptional cases, because it involves the unnecessary sacrifice of healthy hepatic parenchyma. Conservative surgery and alternative procedures should be restricted to the treatment of clear cysts and to patients who cannot undergo radical surgery., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: The liver is the most frequent site of liver metastases (LM) from colorectal cancer. Because of short life expectancies and improved nonoperative modalities, the role of liver resection in elderly patients with LM is unclear., Methods: During a 15-year period, 197 patients underwent liver resection for colorectal metastases. This study was designed to compare morbidity, mortality, and long-term outcome after hepatic resection in patients aged 70 years and older and in patients younger than 70. According to the age at the time of operation, patients were divided into two groups. Group A included patients aged 70 years or older and group B included younger patients., Results: The clinical and pathologic parameters of the two groups were compared and tested as factors affecting early and long-term outcomes after resection. A modified oncologic clinical risk score (CRS) was tested on this series of patients. Overall morbidity was 16.3% (group A 20.7% vs group B 14.6%; P=0.18). Hospital mortality was 3% (5.7% in group A and 2.1% in group B; P=0.19). Actuarial 5 years survival were 30% in group A and 38% in group B (P=ns)., Discussion: The presence of more than three Fong's CRS parameters and microscopic involvement of resectional margin directly affected survival. Under meticulous preoperative assessment and postoperative care, liver resection for LM is justified in patients over 70 years of age; age by itself may not be a controindication to surgery.