Skip to main content

Perioperative Outcomes of Laparoscopic Minor Hepatectomy for Hepatocellular Carcinoma in the Elderly

World Journal of Surgery volume 42, pages 4063–4069 (2018)Cite this article

Abstract

Introduction

This study aims to evaluate the safety and feasibility of laparoscopic minor hepatectomy (LMH) in elderly patients with hepatocellular carcinoma (HCC).

Methods

A total of 40 consecutive elderly (≥ 70 years) patients were compared with 94 young patients (< 70 years). The 40 patients were also compared with 85 consecutive elderly patients who underwent open minor hepatectomies (OMH). After 1:1 propensity-score matching (PSM), 32 LMHs were compared with 32 OMHs in elderly patients.

Results

Comparison between the baseline characteristics of elderly and young HCC patients showed that elderly patients were significantly more likely to have comorbidities, ASA score > 2, non-hepatitis B, previous liver resection and larger tumor size. Comparison between perioperative outcomes demonstrated that elderly patients were significantly more likely to have a longer operation time, increased blood loss, increased need for blood transfusion, longer Pringles duration and longer postoperative stay. Comparison between LMH and OMH in elderly patients demonstrated no significant difference in baseline characteristics except the LMH cohort were significantly more likely to have > 1 comorbidity, higher platelet count and lower median AFP level. Comparison between outcomes before and after PSM demonstrated that LMH was associated with longer operation time, increased blood loss, longer Pringles duration but decreased postoperative pulmonary complications and shorter postoperative stay compared to OMH.

Conclusion

LMH is safe and feasible in elderly patients with HCC. However, LMH in elderly patients is associated with poorer perioperative outcomes compared to LMH in young patients. Comparison between LMH and OMH in elderly patients demonstrated advantages in terms of decreased pulmonary complications and shorter length of stay at the expense of increased operation time and blood loss.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Chan AC, Poon RT, Cheung TT et al (2014) Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: a single-center experience. J Gastro Hepatol 29:1279–1283

    Article  Google Scholar 

  2. Nomi T, Fuks D, Kawaguchi Y (2015) Laparoscopic major hepatectomy for colorectal liver metastases in elderly patients: a single-center, case-matched study. Surg Endosc 29:1368–1375

    Article  Google Scholar 

  3. World Health Statistics (2016) Monitoring health for the SDGs Annex B: tables of health statistics by country, WHO region and globally. World Health Organization, Geneva, p 2016

    Google Scholar 

  4. Cucchetti A, Sposito C, Pinna AD et al (2016) Effect of age on survival in patients undergoing resection of hepatocellular carcinoma. Br J Surg 103:e93–e99

    CAS  Article  Google Scholar 

  5. Faber W, Stockmann M, Schirmer C et al (2014) Significant impact of patient age on outcome after liver resection for HCC in cirrhosis. EJSO 40:208–213

    CAS  Article  Google Scholar 

  6. Wang WL, Zhu Y, Cheng J et al (2014) Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis. Eur J Gas Hepatol 26:444–451

    Article  Google Scholar 

  7. Bauschke A, Altendorf-Hofmann A, Mothes H et al (2016) Partial liver resection results in a significantly better long-term survival than locally ablative procedures even in elderly patients. J Cancer Res Clin Oncol 142:1099–1108

    CAS  Article  Google Scholar 

  8. Ciria R, Cherqui D, Geller DA et al (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

    Article  Google Scholar 

  9. Sposito C, Battiston C, Facciorusso A et al (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880

    CAS  Article  Google Scholar 

  10. Takahara T, Wakabayashi G, Beppu T et al (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727

    Article  Google Scholar 

  11. Han HS, Shehta A, Ahn S et al (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650

    Article  Google Scholar 

  12. Badawy A, Seo S, Toda R et al (2017) A propensity score-based analysis of laparoscopic liver resection for liver malignancies in elderly patients. J Invest Surg 17:1–8

    Article  Google Scholar 

  13. Martinez-Cecilia D, Cipriani F, Vishal S et al (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265:1192–1200

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and result of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  15. Goh BK, Chan CY, Wong JS et al (2015) Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy. Surg Endosc 29:2636–2642

    Article  Google Scholar 

  16. Goh BK, Teo JY, Chan CY et al (2017) Evolution of laparoscopic liver resection at Singapore General Hospital: a nine-year experience of 195 consecutive resections. Singap Med J 58:708–713

    Article  Google Scholar 

  17. Goh BK, Teo JY, Lee SY et al (2018) Critical appraisal of the impact of individual surgeon experience on the outcomes of laparoscopic liver resection in the modern era: collective experience of multiple surgeons at a single institution with 324 consecutive cases. Surg Endosc 32(4):1802–1811

    Article  Google Scholar 

  18. Strasberg SM (2005) Nomenclature of Hepatic anatomy and resection: a review of Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12(5):351–355

    Article  Google Scholar 

  19. Uchida H, Iwashita Y, Watanabe K, Takayama H et al (2015) Surgical outcomes of laparoscopic liver resection in elderly patients: a comparative study from a single center. Surg Laparosc Endosc Percutan Tech 25:e109–e112

    Article  Google Scholar 

  20. Cauchy F, Fuks D, Nomi T et al (2016) Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 222:174–184

    Article  Google Scholar 

  21. Wang XT, Wang HG, Duan WD et al (2015) Pure laparoscopic versus open liver resection for primary liver carcinoma in elderly patients. Medicine 94:e1854

    Article  Google Scholar 

  22. Spampinato MG, Arvanitakis M, Puleo F et al (2013) Totally laparoscopic liver resections for primary and metastatic cancer in elderly: safety, feasibility and short-term outcomes. Surg Endosc 27:1881–1886

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore

    Brian K. P. Goh, Darren Chua, Nicholas Syn, Jin-Yao Teo, Chung-Yip Chan, Ser-Yee Lee, Prema Raj Jeyaraj, Peng-Chung Cheow, Pierce K. H. Chow, London L. P. J. Ooi & Alexander Y. F. Chung

  2. Duke-National University of Singapore Medical School, Singapore, Singapore

    Brian K. P. Goh, Pierce K. H. Chow & London L. P. J. Ooi

  3. Yong Loo Lin School of Medicine, Singapore, Singapore

    Nicholas Syn

Authors
  1. Brian K. P. Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darren Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas Syn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin-Yao Teo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chung-Yip Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ser-Yee Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Prema Raj Jeyaraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peng-Chung Cheow
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pierce K. H. Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. London L. P. J. Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alexander Y. F. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BKG and AYC contributed to conception and design, analysis and interpretation of data, drafting of article, final approval, DC contributed to acquisition, analysis and interpretation of data, critical revision, final approval, NS contributed to analysis and interpretation of data, critical revision, JYT, CYC, SYL, PCC and LLO contributed to conception and design, analysis and interpretation of data, critical revision of article, final approval, PRJ contributed to acquisition, analysis and interpretation of data, critical revision of article, final approval, PKC contributed to analysis and interpretation of data, critical revision of article, final approval.

Corresponding author

Correspondence to Brian K. P. Goh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Goh, B.K.P., Chua, D., Syn, N. et al. Perioperative Outcomes of Laparoscopic Minor Hepatectomy for Hepatocellular Carcinoma in the Elderly. World J Surg 42, 4063–4069 (2018). https://doi.org/10.1007/s00268-018-4741-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4741-4