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Letter| Volume 49, ISSUE 3, P677-678, March 2023

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Reply to: Does age affect the short- and long-term outcomes of patients undergoing liver resection for hepatocellular carcinoma?

  • Brian K.P. Goh
    Correspondence
    Corresponding author. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia, 169856, Singapore.
    Affiliations
    Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
    Duke-National University of Singapore Medical School, Singapore
    Liver Transplant Service, Singhealth-Duke-National University of Singapore Transplant Center, Singapore
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  • Laura L.Y. Tan
    Affiliations
    Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
    Ministry of Health Holdings, Singapore
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  • Nicholas Syn
    Affiliations
    Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
    Ministry of Health Holdings, Singapore
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Published:January 07, 2022DOI:https://doi.org/10.1016/j.ejso.2022.01.005
      We would like to thank Dr Sun and colleagues [
      • Sun L.Y.
      • Diao Y.K.
      • Li C.
      • et al.
      Does age effect on the short- and long-term outcomes of patients undergoing liver resection for hepatocellular carcinoma?.
      ] for their interest in our manuscript [
      • Tan L.L.Y.
      • Chew V.T.W.
      • Syn N.
      • et al.
      Effect of age on the short- and long-term outcomes of patients undergoing curative liver resection for HCC.
      ]. The authors correctly pointed out that there were significant differences in the baseline clinicopathologic characteristics between the 3 age groups and suggested that propensity-score matching (PSM) could be used to control for these baseline imbalances [
      • Sun L.Y.
      • Diao Y.K.
      • Li C.
      • et al.
      Does age effect on the short- and long-term outcomes of patients undergoing liver resection for hepatocellular carcinoma?.
      ]. However, we would like to highlight that our study had already adjusted for confounding biases using principal components analyses [
      • Lin Z.
      • Yang C.
      • Zhu Y.
      • Duchi J.
      • Fu Y.
      • Wang Y.
      • et al.
      Simultaneous dimension reduction and adjustment for confounding variation.
      ]. Propensity-score (PS) methodologies represent one of a very large array of statistical approaches used to address confounding biases in observational cohorts. With regards to the present study, PS methodologies, as a whole (not limited to PS matching [PSM], but also other PS techniques as PS stratification [PSS], adjustment [PSA], and inverse probability of treatment-weighting [IPTW]), may be inappropriate in the specific context of our study for the following reasons.

      Keywords

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      References

        • Sun L.Y.
        • Diao Y.K.
        • Li C.
        • et al.
        Does age effect on the short- and long-term outcomes of patients undergoing liver resection for hepatocellular carcinoma?.
        EJSO. 2021; (in press)
        • Tan L.L.Y.
        • Chew V.T.W.
        • Syn N.
        • et al.
        Effect of age on the short- and long-term outcomes of patients undergoing curative liver resection for HCC.
        Eur J Surg Oncol. 2021; https://doi.org/10.1016/j.ejso.2021.12.027
        • Lin Z.
        • Yang C.
        • Zhu Y.
        • Duchi J.
        • Fu Y.
        • Wang Y.
        • et al.
        Simultaneous dimension reduction and adjustment for confounding variation.
        Proc Natl Acad Sci Unit States Am. 2016; 113 (Dec 20): 14662-14667
        • Goh B.K.
        • Syn N.
        • Koh Y.X.
        • et al.
        Comparison between short and long-term outcomes after minimally invasive versus open liver resections for hepatocellular carcinoma: a 1:1 matched analysis.
        J Surg Oncol. 2021; 124: 560-571
        • Goh B.K.
        • Syn N.
        • Lee S.Y.
        • et al.
        Impact of liver cirrhosis on the difficulty of minimally0invasive liver resections: a 1:1 coarsened exact-matched controlled study.
        Surg Endosc. 2021; 35: 5231-5238
        • Goh B.K.
        • Chua D.
        • Syn N.
        • et al.
        Perioperative outcomes of laparoscopic minor hepatectomy for hepatocellular carcinoma in the elderly.
        World J Surg. 2018; 42: 4063-4069

      Linked Article

      • Letter to editor: Does age effect on the short- and long-term outcomes of patients undergoing liver resection for hepatocellular carcinoma?
        European Journal of Surgical OncologyVol. 48Issue 4
        • Preview
          With great interest we read the article by Tan and colleagues and congratulate the authors on their work describing the effect of age on the short- and long-term outcomes of patients with hepatocellular carcinoma (HCC) undergoing curative-intent liver resection [1]. In this retrospective study, length of postoperative hospital stay, postoperative complications and 90-day mortality, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were analyzed and compared among three age groups: 764 young patients (<70 years), 278 septuagenarian patients (70–79 years) and 50 octogenarian patients (≥80 years).
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