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Benefits of laparoscopic liver resection in elderly patients

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Abstract

Background

The indications of laparoscopic liver resection (LLR) have expanded to high-risk patients, such as elderly people. However, to date, little evidence has been established of the safety and feasibility of LLR in elderly patients. The short-term outcomes of LLR in elderly patients as compared to non-elderly patients were investigated.

Methods

Data of a total of 297 patients who underwent LLR were reviewed. Among these 297 patients, 181 patients were < 75 years age (non-elderly) and 116 patients were ≥ 75 years age (elderly), and the surgical outcomes were compared between the groups. In addition, we evaluated the risk factors for postoperative morbidity (Clavien-Dindo grade ≥ IIIa) utilizing the preoperative, operative, and postoperative variables

Results

The preoperative liver/renal function, frequency of anti-thrombotic drug use, number of comorbidities, and American Society of Anesthesiologists-physical status classification were more unfavorable in elderly patients than in non-elderly patients. No significant inter-group differences were observed in the operation time, blood loss, conversion rate, postoperative morbidity, or 30-day mortality. The 3-year overall survival rate was comparable between the two groups. Multivariate analysis identified anti-thrombotic drug use, operation time > 7 h, and peak serum total bilirubin > 2 mg/dl within postoperative day 3 as independent risk factors for Clavien-Dindo ≥ IIIa postoperative morbidity (P = 0.016, P < 0.001, and P = 0.001, respectively).

Conclusions

LLR in elderly patients may provide comparable short-term outcomes to those in non-elderly patients.

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Abbreviations

ASA-PS:

American Society of Anesthesiologists-physical status

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

AR:

Anatomic resection

CI:

Confidence interval

CKD:

Chronic kidney disease

COPD:

Chronic obstructive pulmonary disease

CRLM:

Colorectal liver metastasis

CVA:

Cerebrovascular accident

DM:

Diabetes mellitus

DS:

Difficulty score

HALS:

Hand-assist laparoscopic surgery

HCC:

Hepatocellular carcinoma

ICGR15:

Indocyanine green retention rate at 15 min

IL:

Interleukin

LLR:

Laparoscopic liver resection

LR:

Liver resection

OLR:

Open liver resection

OR:

Odds ratio

OS:

Overall survival

PCI:

Percutaneous coronary intervention

POD:

Postoperative day

PT:

Prothrombin time

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Acknowledgement

The authors did not receive any funding/grant support for this study.

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Authors and Affiliations

  1. Ageo Central General Hospital, Department of Surgery, Center for Advanced Treatment of HBP Diseases, 1-10-10 Kashiwaza, Ageo, Saitama, 362-8588, Japan

    Shozo Mori, Taiga Wakabayashi, Kohei Mishima, Takahiro Ozaki, Yoshiki Fujiyama & Go Wakabayashi

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  1. Shozo Mori
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  2. Taiga Wakabayashi
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  3. Kohei Mishima
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  4. Takahiro Ozaki
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  5. Yoshiki Fujiyama
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  6. Go Wakabayashi
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Contributions

Study concept and design, and drafting of the manuscript: SM; data collection: SM, TW, KM, T.O, and YF; critical revision of the manuscript: GW; study supervision: GW.

Corresponding author

Correspondence to Shozo Mori.

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Disclosure

Drs. Shozo Mori, Taiga Wakabayashi, Kohei Mishima, Takahiro Ozaki, Yoshiki Fujiyama, and Go Wakabayashi have no conflicts of interest or financial ties to disclose.

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Mori, S., Wakabayashi, T., Mishima, K. et al. Benefits of laparoscopic liver resection in elderly patients. Surg Endosc 37, 5205–5214 (2023). https://doi.org/10.1007/s00464-023-09986-9

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  • DOI: https://doi.org/10.1007/s00464-023-09986-9

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