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Sioutas et al. Hepatoma Res 2020;6:4 Hepatoma Research
DOI: 10.20517/2394-5079.2019.43

Review Open Access

Frailty and Liver resection: where do we stand?

Georgios S. Sioutas , Ioannis A. Ziogas , Georgios Tsoulfas 2
1,#
2,#
1 Department of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis 68100, Greece.
2 First Department of Surgery, Papageorgiou University Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece.
# Authors contributed equally.

Correspondence to: Dr. Georgios Tsoulfas, FICS, FACS, Associate Professor of Surgery, First Department of Surgery, Papageorgiou
University Hospital, Aristotle University of Thessaloniki, 66 Tsimiski Street, Thessaloniki 54622, Greece. E-mail: tsoulfasg@gmail.com

How to cite this article: Sioutas GS, Ziogas IA, Tsoulfas G. Frailty and Liver resection: where do we stand? Hepatoma Res 2020;6:4.
http://dx.doi.org/10.20517/2394-5079.2019.43

Received: 3 Dec 2019 First Decision: 15 Jan 2020 Revised: 22 Jan 2020 Accepted: 10 Feb 2020 Published: 20 Feb 2020

Science Editor: Bruno Nardo Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
As the world population is continuously aging, the number of older patients requiring liver surgery is also on the
rise. Data have shown that age should not be a limiting factor for liver resection, as it cannot accurately predict
postoperative outcomes. Instead, frailty can serve as a more reliable measure of the patient’s overall health and
functional reserves. Several frailty assessment tools have been implemented for preoperative risk stratification
before liver surgery, and higher scores have commonly been associated with postoperative morbidity, mortality,
and length of hospital stay. However, no consensus has been reached on the most useful screening tool. Future
studies should focus on comparing the currently available assessment tools, constructing a liver resection-specific
tool, and assessing the role of frailty assessment tools in preoperative patient optimization.

Keywords: Frailty, age, elderly, liver resection, liver surgery, morbidity, morbidity, complications

INTRODUCTION
Liver resection is the current standard of care for most patients with benign or malignant liver lesions and
[1,2]
adequate liver function . Advances in healthcare have led to a continually increasing life-expectancy,
[2,3]
which consequently leads to a higher number of elderly patients (> 60 years) being offered liver surgery .
Several studies sought to compare liver resection in younger vs. older surgical candidates and reported
varying yet acceptable outcomes in appropriately selected older individuals [2,4-8] . In fact, morbidity and
mortality rates in patients undergoing liver resection for hepatocellular carcinoma (HCC) seem to range

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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