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Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score‑based analysis

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Abstract

Background

Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM).

Methods

We performed a multicentric retrospective study including 184 consecutive cases of HCC major liver resection in patients aged ≥ 70 years in _8 European Hospital Centers. Patients were divided into LMH and OMH groups, and perioperative and long-term outcomes were compared between the 2 groups.

Results

After propensity score matching, 122 patients were enrolled, 38 in the LMH group and 84 in the OMH group. Postoperative overall complications were lower in the LMH than in the OMH group (18 vs. 46%, p < 0.001). Hospital stay was shorter in the LMH group than in the OMH group (5 vs. 7 days, p = 0.01). Mortality at 90 days was comparable between the two groups. There were no significant differences between the two groups in terms of overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5 years.

Conclusion

LMH for HCC is associated with appropriate short-term outcomes in patients aged ≥ 70 years as compared to OMH. LMH is safe and feasible in elderly patients with HCC.

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Authors and Affiliations

  1. General Surgery, University Hospital Policlinico of Bari, Bari, Italy

    Antonella Delvecchio & Maria Conticchio

  2. Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy

    Francesca Ratti & Luca Aldrighetti

  3. Department of Surgical Oncology, Institute of Oncology Gustave Roussy, Villejuif, France

    Maximiliano Gelli

  4. Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France

    Maximiliano Gelli, Rene Adam & Daniel Cherqui

  5. Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain

    Ferdinando Massimiliano Anelli & Javier Briceño-Delgado

  6. Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France

    Alexis Laurent & Nicola de’Angelis

  7. Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

    Giulio Cesare Vitali

  8. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy

    Paolo Magistri, Giacomo Assirati & Fabrizio Di Benedetto

  9. Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France

    Emanuele Felli, Taiga Wakabayashi & Patrick Pessaux

  10. Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France

    Tullio Piardi

  11. Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France

    Tullio Piardi

  12. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy

    Riccardo Memeo

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  1. Antonella Delvecchio
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  2. Maria Conticchio
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Correspondence to Riccardo Memeo.

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Antonella Delvecchio, Maria Conticchio, Francesca Ratti, Maximiliano Gelli, Ferdinando Massimiliano Anelli, Alexis Laurent, Giulio Cesare Vitali, Paolo Magistri, Federica Mereu, Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Tullio Piardi, Fabrizio Di Benedetto, Nicola de’Angelis, Javier Briceno, Rene Adam, Daniel Cherqui, Luca Aldrighetti, and Riccardo Memeo declare that they have no conflicts of interest or financial ties to disclose.

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Delvecchio, A., Conticchio, M., Ratti, F. et al. Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity score‑based analysis. Surg Endosc 35, 3642–3652 (2021). https://doi.org/10.1007/s00464-020-07843-7

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