Background: To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC), we compared the outcome between LLR and conventional open liver resection (OLR) in patient groups with different IWATE criteria difficulty scores (DS). Methods: We retrospectively reviewed 607 primary HCC patients (LLR: 81, OLR: 526) who underwent liver resection in Linkou Chang Gung Memorial hospital from 2012 to 2019. By using 1:1 propensity score-matched (PSM) analysis, their baseline characteristics and the DS stratified by the IWATE criteria were matched between the LLR and OLR. Their perioperative and oncologic outcomes were compared. Results: After 1:1 PSM, 146 patients (73 in LLR, 73 in OLR) were analyzed. Among them, 13, 41, 13 and 6 patients were classified as low, intermediate, advanced and expert DS group, respectively. Compared to OLR, the LLR had shorter hospital stay (9.4 vs. 11.5 days, p = 0.071), less occurrence of surgical complications (16.4% vs. 30.1%, p = 0.049), lower rate of hepatic inflow control (42.5% vs. 65.8%, p = 0.005), and longer time of inflow control (70 vs. 51 min, p = 0.022). The disease-free survival (DFS) and overall survivals were comparable between the two groups. While stratified by the DS groups, the LLR tended to have lower complication rate and shorter hospital stay than OLR. The DFS of LLR in the intermediate DS group was superior to that of the OLR (p = 0.020). In the advanced and expert DS groups, there were no significant differences regarding outcomes between the two groups. Conclusion: We have demonstrated that with sufficient experience and technique, LLR for HCC is feasible and the perioperative outcome is favorable. Based on the current study, we suggest LLR should be a standard procedure for HCC with low or intermediate difficulty. It can provide satisfactory postoperative recovery and comparable oncological outcomes. Further larger scale prospective studies are warranted to validate our findings.

Introduction: With a growing elderly population, the pancreatic surgeon is increasingly required to determine whether older patients with pancreatic cancer should undergo a pancreaticoduodenectomy. This operation offers the only potentially curative treatment, however questions remain as to the safety and feasibility of PD in this elderly population.This study aims to provide evidence from a high-volume single-centre for the safety and feasibility of pancreaticoduodenectomy in patients aged 75 years and above. Method: A retrospective review of a prospectively maintained database was performed, including all patients who underwent pancreaticoduodenectomy by a single surgeon between 2007-2019. Patients were divided into two groups, those 75 years or older and patients younger than 75. Patient characteristics, operative and post-operative outcomes were reviewed and compared between the two groups. Results: Of the 282 patients who underwent pancreaticoduodenectomy, 67 (24%) patients were 75 years or above. This included, 20 (30%) elderly patients who also underwent portal vein reconstruction, compared with 78 (36%) patients in the younger group. Overall perioperative mortality was low at 1/67 (1.5%) in the elderly group, compared with 1/215 (0.5%) in the younger group. Overall complication and major complication rates were 17/67 (25%) and 3/67 (4%) in the elderly group respectively, which were comparable to the younger group with 28/215 (13%) and 1/215 (0.5%) respectively. Conclusion: Carefully selected elderly patients can safely undergo pancreaticoduodenectomy with low rates of morbidity and mortality. Although higher than the younger patients, morbidity and mortality rates remain low for an operation which provides the only potential curative treatment.

Background Laparoscopic liver resections (LLR) have been shown a treatment approach comparable to open liver resections (OLR) in hepatocellular carcinoma (HCC). However, the influence of procedural type on body composition has not been investigated. The aim of the current study was to compare the degree of skeletal muscle loss between LLR and OLR for HCC. Methods By using propensity score matching (PSM) analysis, 64 pairs of patients were enrolled. The change of psoas muscle index (PMI) after the operation was compared between the matched patients in the LLR and OLR. Risk factors for significant muscle loss (defined as change in PMI > mean change minus one standard deviation) were further investigated by multivariate analysis. Results Among patients enrolled, there was no significant difference in baseline characteristics between the two groups. The PMI was significantly decreased in the OLR group (P = 0.003). There were also more patients in the OLR group who developed significant muscle loss after the operations (P = 0.008). Multivariate analysis revealed OLR (P = 0.023), type 2 diabetes mellitus, indocyanine green retention rate at 15 min (ICG-15) > 10%, and cancer stage ≧ 3 were independent risk factors for significant muscle loss. In addition, significant muscle loss was associated with early HCC recurrence (P = 0.006). Metabolomic analysis demonstrated that the urea cycle may be decreased in patients with significant muscle loss. Conclusion LLR for HCC was associated with less significant muscle loss than OLR. Since significant muscle loss was a predictive factor for early tumor recurrence and associated with impaired liver metabolism, LLR may subsequently result in a more favorable outcome.