Surgical Endoscopy

, Volume 29, Issue 6, pp 1368–1375 | Cite as

Laparoscopic major hepatectomy for colorectal liver metastases in elderly patients: a single-center, case-matched study

  • Takeo Nomi
  • David Fuks
  • Yoshikuni Kawaguchi
  • Frederic Mal
  • Yoshiyuki Nakajima
  • Brice Gayet



The incidence of colorectal cancer liver metastases (CRLM) among elderly patients has increased; therefore, older patients are increasingly being considered for hepatic resection. However, data regarding the outcome of laparoscopic major hepatectomy (LMH) in elderly patients are limited. The aim of this study was to evaluate the safety and feasibility of LMH in elderly patients with CRLM.


From January 1998 to September 2013, a total of 31 patients aged ≥70 years (elderly group) were matched with 62 patients <70 years (young group) by demographics, tumor characteristics, and details of surgical procedures.


The elderly group was characterized by a higher incidence of hypertension (41.9 vs. 17.7 %, P = 0.022), ≥2 comorbidities (32.3 vs. 11.3 %, P = 0.021), and lower prevalence of metastatic rectal cancer (12.9 vs. 38.7 %, P = 0.015). Intraoperative variables, such as surgical duration (300 vs. 240 min, P = 0.920), blood loss (400 vs. 300 mL, P = 0.361), and transfusion rate (9.7 vs. 12.9 %, P = 0.726), were not notably different between the groups. Postoperative mortality (0 vs. 0 %), complications (54.8 vs. 41.9 %, P = 0.276), and major complications (27.4 vs. 16.1 %, P = 0.303, respectively) were comparable between the groups. The 3-year overall survival rates were 61.7 % in the young group (median 40 months) and 57.9 % in the elderly group (median 39 months), respectively (P = 0.842).


Our results clearly demonstrated that LMH for CRLM could be safely performed in elderly patients; thus, advanced age itself should not be regarded as a contraindication for LMH.


Laparoscopic liver resection Major hepatectomy Elderly patients 



The authors thank Mahendran Govindasamy, Kenichiro Araki, and Satoshi Ogiso for coordinating patient follow-up and maintaining the prospective database that formed the basis of this study.


Takeo Nomi, David Fuks, Yoshikuni Kawaguchi, Frederic Mal, Yoshiyuki Nakajima, and Brice Gayet have no conflict of interest and financial ties to disclose.


  1. 1.
  2. 2.
    Petrowsky H, Clavien PA (2005) Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients? World J Surg 29:1093–1100CrossRefPubMedGoogle Scholar
  3. 3.
    Repetto L, Granetto C, Venturino A (1997) Comorbidity and cancer in the aged: the oncologists point of view. Rays 22:17–19PubMedGoogle Scholar
  4. 4.
    Nagano Y, Nojiri K, Matsuo K, Tanaka K, Togo S, Ike H, Shimada H (2005) The impact of advanced age on hepatic resection of colorectal liver metastases. J Am Coll Surg 201:511–516CrossRefPubMedGoogle Scholar
  5. 5.
    Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassini D, De Santis M, Colace L, Brozzetti S (2007) Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis 22:77–83CrossRefPubMedGoogle Scholar
  6. 6.
    Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ, LiverMetSurvey Centres (2010) Liver resection of colorectal metastases in elderly patients. Br J Surg 97:366–376CrossRefPubMedGoogle Scholar
  7. 7.
    Di Benedetto F, Berretta M, D’Amico G, Montalti R, De Ruvo N, Cautero N, Guerrini GP, Ballarin R, Spaggiari M, Tarantino G, Di Sandro S, Pecchi A, Luppi G, Gerunda GE (2011) Liver resection for colorectal metastases in older adults: a paired matched analysis. J Am Geriatr Soc 59:2282–2290CrossRefPubMedGoogle Scholar
  8. 8.
    Cannon RM, Martin RC, Callender GG, McMasters KM, Scoggins CR (2011) Safety and efficacy of hepatectomy for colorectal metastases in the elderly. J Surg Oncol 104:804–808CrossRefPubMedGoogle Scholar
  9. 9.
    Kulik U, Framke T, Grosshennig A, Ceylan A, Bektas H, Klempnauer J, Lehner F (2011) Liver resection of colorectal liver metastases in elderly patients. World J Surg 35:2063–2072CrossRefPubMedGoogle Scholar
  10. 10.
    Cook EJ, Welsh FK, Chandrakumaran K, John TG, Rees M (2012) Resection of colorectal liver metastases in the elderly: does age matter? Colorectal Dis 14:1210–1216CrossRefPubMedGoogle Scholar
  11. 11.
    Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689CrossRefPubMedGoogle Scholar
  12. 12.
    Gumbs AA, Gayet B (2007) Totally laparoscopic left hepatectomy. Surg Endosc 21:1221CrossRefPubMedGoogle Scholar
  13. 13.
    Gumbs AA, Bar-Zakai B, Gayet B (2008) Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 12:1152CrossRefPubMedGoogle Scholar
  14. 14.
    Gumbs AA, Gayet B (2008) Multimedia article. Totally laparoscopic extended right hepatectomy. Surg Endosc 22:2076–2077CrossRefPubMedGoogle Scholar
  15. 15.
    Gumbs AA, Gayet B (2008) Totally laparoscopic central hepatectomy. J Gastrointest Surg 12:1153CrossRefPubMedGoogle Scholar
  16. 16.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841CrossRefPubMedGoogle Scholar
  17. 17.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS; World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830Google Scholar
  18. 18.
    Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250:849–855CrossRefPubMedGoogle Scholar
  19. 19.
    Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F (2008) Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc 22:2208–2213CrossRefPubMedGoogle Scholar
  20. 20.
    Ito K, Ito H, Are C, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, D’Angelica MI (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 13:2276–2283CrossRefPubMedGoogle Scholar
  21. 21.
    Reddy SK, Barbas AS, Turley RS, Steel JL, Tsung A, Marsh JW, Geller DA, Clary BM (2011) A standard definition of major hepatectomy: resection of four or more liver segments. HPB 13:494–502CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Azoulay D, Castaing D, Krissat J, Smail A, Hargreaves GM, Lemoine A, Emile JF, Bismuth H (2000) Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver. Ann Surg 232:665–672CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  24. 24.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRefPubMedGoogle Scholar
  25. 25.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 discussion 828–829CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Ishizawa T, Hasegawa K, Kokudo N, Sano K, Imamura H, Beck Y, Sugawara Y, Makuuchi M (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51CrossRefPubMedGoogle Scholar
  28. 28.
    Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Buchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRefPubMedGoogle Scholar
  29. 29.
    Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860CrossRefPubMedGoogle Scholar
  30. 30.
    Topal H, Tiek J, Aerts R, Topal B (2012) Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc 26:2451–2455CrossRefPubMedGoogle Scholar
  31. 31.
    Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ (2006) Outcomes after major hepatectomy in elderly patients. J Am Coll Surg 203:677–683CrossRefPubMedGoogle Scholar
  32. 32.
    Reddy SK, Barbas AS, Turley RS, Gamblin TC, Geller DA, Marsh JW, Tsung A, Clary BM, Lagoo-Deenadayalan S (2011) Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg 212:787–795CrossRefPubMedGoogle Scholar
  33. 33.
    Tzeng CW, Cooper AB, Vauthey JN, Curley SA, Aloia TA (2013) Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB 16(5):459–468CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Cescon M, Grazi GL, Del Gaudio M, Ercolani G, Ravaioli M, Nardo B, Cavallari A (2003) Outcome of right hepatectomies in patients older than 70 years. Arch Surg 138:547–552CrossRefPubMedGoogle Scholar
  35. 35.
    Hanazaki K, Kajikawa S, Shimozawa N, Shimada K, Hiraguri M, Koide N, Adachi W, Amano J (2001) Hepatic resection for hepatocellular carcinoma in the elderly. J Am Coll Surg 192:38–46CrossRefPubMedGoogle Scholar
  36. 36.
    Ford GT, Rosenal TW, Clergue F, Whitelaw WA (1993) Respiratory physiology in upper abdominal surgery. Clin Chest Med 14:237–252PubMedGoogle Scholar
  37. 37.
    Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, Scatton O (2014) A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal approach. Ann SurgGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Takeo Nomi
    • 1
    • 2
  • David Fuks
    • 1
  • Yoshikuni Kawaguchi
    • 1
  • Frederic Mal
    • 1
  • Yoshiyuki Nakajima
    • 2
  • Brice Gayet
    • 1
  1. 1.Department of Digestive Disease, Institut Mutualiste MontsourisUniversité Paris-DescartesParisFrance
  2. 2.Department of SurgeryNara Medical UniversityNaraJapan

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