As society advances, chronic liver disease has been effectively controlled and natural life expectancy has increased over the decades, while the incidence of hepatocellular liver cancer (HCC) has similarly increased, with most patients still opting for hepatectomy because of the shortage of liver transplant organs. Is the benefit of hepatectomy really evident in elderly HCC patients? Recently, Cucchetti et al. from the University of Bologna have provided their answer to this question, with results published in the British Journal of Surgery. Study Description: The study included 919 patients with hepatocellular liver cancer with cirrhosis, divided into groups under 60 years old (229), 60-66 years old (230), 67-70 years old (231) and over 70 years old (229). Long-term survival is inevitably affected by age, so there is inevitably a bias between the survival rates of different age groups, and of course, other clinical features and tumor manifestations besides age can lead to prognostic changes. Therefore, relative survival is a more objective evaluation method, which needs to be derived by comparing the observed survival of the sample with the survival of the matched non-tumor patient population. Years of life lost (YLL) is an indicator of relative survival, i.e., the difference between the patient’s life expectancy due to death from disease and the average life expectancy. A comparison of YLL after hepatectomy in patients with hepatocellular liver cancer at different ages provides a relatively objective description of the differences between groups. Based on data from the 919 patients included in the study, the overall mean age was at 65.7 years, with the lower age groups having a higher proportion of males and a lower proportion of HCV infections among the four age subgroups. The median duration of follow-up (0-13 years) was 5.5 years, with 512 cases of tumor recurrence and 387 deaths, and overall survival rates of 89.2%, 70.7%, 54.1% and 28.6% at 1, 3, 5 and 10 years, respectively. The researchers matched age and sex to obtain a control group with an overall mean life expectancy of 17.4 years, compared with a mean life expectancy of 8.7 years after hepatectomy in the case group, and a YLL of 8.6 years lost after hepatectomy. Specifically for each age group, the YLL was lower in the older age group, although the survival time was shorter. Specifically, the group under 60 had the longest postoperative survival (15.6 years) but the greatest YLL (11.0 years), and the group over 70 had the shortest postoperative survival (6.4 years) but the least YLL (3.7 years). Therefore, the investigators concluded that the lower YLL in older patients is strong evidence in favor of surgical treatment and has clear implications for clinical practice. Implications: Because of the direct observation that older patients have a lower survival rate compared to younger patients, approximately 25% less postoperative survival per year longer than 10 years, many argue that the benefit of surgical treatment is limited in older patients with hepatocellular liver cancer with cirrhosis, thus preferring less invasive and less effective treatment modalities. When we look at the overall lifespan from birth, there is still a clear benefit of surgical treatment for these older patients, even with fewer years of life lost than for younger patients. However, this is discussed when liver transplantation is excluded, and older patients can still have a good outcome with hepatectomy. For patients who can receive liver transplantation, liver transplantation remains the best treatment, specifically for the data in this study, patients under 70 years of age who met the Milan criteria had a YLL of 10 years after hepatectomy and patients in the same age group had a YLL of 4.0 to 8.6 years after receiving liver transplantation. However, considering issues such as the intractable shortage of liver transplant sources, the evidence provided in this study is still important for guiding patients with advanced liver cancer, especially those who cannot undergo liver transplantation for various reasons, to undergo hepatectomy for their survival instead of opting for low-risk conservative treatment.