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Safety of advanced laparoscopic hepatectomy for elderly patients: a Japanese nationwide analysis

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Abstract

Background

Although basic laparoscopic hepatectomy (LH) has become the standard procedure for hepatectomy, the safety of advanced LH remains to be clarified, especially in elderly patients. We investigated the safety of advanced LH in elderly Japanese patients.

Methods

Elderly patients (≥ 65 years) who underwent advanced LH between 2016 and 2021 were analyzed using a nationwide claims database in Japan. The perioperative outcomes of patients who underwent open hepatectomy (OH group) or LH (LH group) were compared using propensity score matching (PSM). The primary outcome was in-hospital mortality. The E-value method was performed to assess the strength of the outcome point estimates against possible unmeasured confounding factors.

Results

Among 5,021 patients, eligible patients were classified into the OH (n = 4,152) and LH (n = 527) groups. The median patient age was 74 years in both groups. Hepatocellular carcinoma and metastatic liver tumors were the major indications for hepatectomy (OH: 52.5% versus 30.6%; LH: 60.7% versus 26.4%). After PSM, in-hospital mortality rates for OH and LH were 1.7 and 0.76%, respectively. The risk ratio was 0.45 (95% confidence interval, 0.16–1.25; E-value = 3.87). Compared with OH, LH was associated with a longer anesthesia time (411 versus 432 min), lower rate of blood product use (red blood concentrate: 33.5% versus 20.3%; fresh frozen plasma: 29.2% versus 17.1%), and shorter hospital stay (13 versus 12 days).

Conclusions

In elderly patients, the safety of advanced LH was similar to that of advanced OH, or might be better in Japan under the current policy of hospital accreditation.

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Abbreviations

HCC:

Hepatocellular carcinoma

LH:

Laparoscopic hepatectomy

OH:

Open hepatectomy

PSM:

Propensity score matching

RWD:

Real-world data

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Acknowledgements

The authors thank Medical Data Vision Co., Ltd., for providing the database.

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Authors and Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Jiro Kusakabe, Kojiro Taura & Etsuro Hatano

  2. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan

    Jiro Kusakabe, Masayuki Nakashima, Masato Takeuchi & Koji Kawakami

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  1. Jiro Kusakabe
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Correspondence to Koji Kawakami.

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Jiro Kusakabe, Kojiro Taura, Masayuki Nakashima, Masato Takeuchi, Etsuro Hatano, and Koji Kawakami have no conflicts of interest or financial ties to disclose.

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Kusakabe, J., Taura, K., Nakashima, M. et al. Safety of advanced laparoscopic hepatectomy for elderly patients: a Japanese nationwide analysis. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10818-7

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