Age itself should not be considered as a contraindication for high impact surgery. For all high impact surgery, appropriate screening for comorbidities and assessment of patients condition should be commenced during preoperative work-up.

One of the most severe complications after the major liver surgery is the postoperative liver failure. Irrespective of tumor entity, postoperative liver failure is strongly related with the level of resection with underlying parenchymal disease. Also, increased rates of postoperative liver failure after liver surgery in aged patients are documented. But, the aging process of the human liver and its functional outcomes are largely unknown. ^99mTc-mebrofenin hepatobiliary scintigraphy (HBS) with SPECT-CT allows quantitative evaluation of hepatic uptake function.

The main objective of this study was to assess age-dependent changes in total liver function in both normal and affected liver parenchyma patients.

Between 2005 - 2014, 508 patients undertook ^99mTc-mebrofenin hepatobiliary scintigraphy (HBS) for the evaluation of liver function. Among these, 203 patients were healthy livers (group A) and 57 patients were with hepatocellular carcinoma (HCC) and Child-Pugh A (group B). The ^99mTc-mebrofenin-uptake-rate of the whole liver adjusted for body surface area (cMUR) was calculated for all patients. Linear regression analysis was also performed to determine the relationship between age and cMUR.

The results of the study stated that the mean cMUR was 8.50 ± 2.05%/min/m² and 6.94 ± 2.03%/min/m² in group A and B, respectively. The linear correlation that was found between patients age and cMUR in group A was negative. In group B, there was no association between age and cMUR, but an inclination in decline of liver function with age was observed.

Thus, the study concluded that liver function deteriorates with age. As the regenerative capacity of the liver is related to liver function, this outcome should be taken into consideration while evaluating surgical risk in patients who are considered for major liver resection.

Source: Cieslak KP, Baur O, Verheij J, Bennink RJ, van Gulik TM. Liver function declines with increased age. HPB (Oxford). 2016;18(8):691-696. doi: 10.1016/j.hpb.2016.05.011