Surgical Resection of a Giant Hepatocellular Carcinoma in an 89-Year-Old Patient with Multiple Comorbidities: The Role of Frailty Assessment and Preoperative Optimisation—A Case Report and Literature Review

Background and Clinical Significance: Liver cancer incidence increases with age, and surgical resection remains the primary curative option for early-to-intermediate hepatocellular carcinoma. In elderly patients, multimorbidity and frailty complicate risk assessment, so selection should consider more than chronological age. Case Presentation: An 89-year-old woman with hypertension, heart failure, atrial fibrillation on anticoagulation, and significant proximal LAD stenosis underwent preoperative percutaneous revascularisation and a left lateral sectionectomy for a solitary liver mass. Histology confirmed hepatocellular carcinoma; the early postoperative course required brief ICU support for haemodynamic instability and supplemental oxygen, with discharge on postoperative day six. Conclusions: This case report shows that, after multidisciplinary evaluation and targeted preoperative optimisation (including cardiac intervention), selected very elderly patients with multiple comorbidities may be considered for liver resection, though they remain at increased risk of perioperative cardiopulmonary and haemodynamic events. Incorporating frailty, nutritional, and functional assessments alongside comorbidity profiling improves patient selection and supports individualised decision-making.