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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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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840, Shijocho, Kashihara, Nara, 634-8522, Japan

    Takeo Nomi, Daisuke Hokuto & Masayuki Sho

  2. Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan

    Fumitoshi Hirokawa & Koji Komeda

  3. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Masaki Kaibori & Morihiko Ishizaki

  4. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Masaki Ueno & Shinya Hayami

  5. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Shogo Tanaka & Shoji Kubo

  6. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Takehiro Noda & Hidetoshi Eguchi

  7. Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan

    Takuya Nakai & Masataka Matsumoto

  8. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hisashi Ikoma & Ryo Morimura

  9. Division of Gastrointestinal, Breast, and General Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga Prefecture, Japan

    Hiroya Iida & Hiromitsu Maehira

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  1. Takeo Nomi
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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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  • DOI: https://doi.org/10.1007/s00464-019-06812-z

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