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Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a multi-centre propensity score-based analysis

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Abstract

Background

The frequency of liver resection in elderly patients has been increasing. However, data are limited regarding the safety of laparoscopic liver resection (LLR) compared with that of open liver resection (OLR) for hepatocellular carcinoma (HCC) in elderly patients. The present study aimed to compare short-term outcomes between LLR and OLR in elderly patients with HCC using propensity score matching.

Methods

The study included 630 patients (age, ≥ 75 years) who underwent liver resection for HCC at nine liver centres between April 2010 and December 2017. Patients were divided into LLR and OLR groups, and perioperative outcomes were compared between the groups. In addition, subgroup analysis was performed according to age (75–79 and ≥ 80 years).

Results

Of the 630 patients, 221 and 409 were included in the LLR and OLR groups, respectively. After propensity score matching, 155 patients were included in each group. Intraoperative blood loss and the transfusion, post-operative overall complication and major complication rates were lower in the matched LLR than the matched OLR group (P < 0.001, P = 0.004, P < 0.001 and P < 0.001, respectively). Moreover, post-operative pulmonary and cardiovascular complications were less frequent in the matched LLR group (P = 0.008 and P = 0.014, respectively). In subgroup analysis, among octogenarians, the post-operative major complication rate was lower and hospital stay was shorter in the matched LLR than the matched OLR group (P < 0.001 and P < 0.001, respectively).

Conclusion

LLR for HCC is associated with good short-term outcomes in patients aged ≥ 75 years compared with OLR. LLR is safe and feasible in selected octogenarians with HCC.

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Disclosures

Drs.Takeo Nomi, Fumitoshi Hirokawa, Masaki Kaibori, Masaki Ueno, Shogo Tanaka, Daisuke Hokuto, Takehiro Noda, Takuya Nakai, Hisashi Ikoma, Hiroya Iida, Koji Komeda, Morihiko Ishizaki, Shinya Hayami, Hidetoshi Eguchi, Masataka Matsumoto, Ryo Morimura, Hiromitsu Maehira, Masayuki Sho and Shoji Kubo have no conflicts of interest or financial ties to disclose.

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Correspondence to Takeo Nomi.

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Nomi, T., Hirokawa, F., Kaibori, M. et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a multi-centre propensity score-based analysis. Surg Endosc 34, 658–666 (2020). https://doi.org/10.1007/s00464-019-06812-z

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Keywords

  • Laparoscopic liver resection
  • Elderly
  • Hepatocellular carcinoma
  • Propensity score matching
  • Ageing