Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Abstract

It remains unclear whether the short-term benefits and long-term outcomes of laparoscopic liver resection (LLR) accrue to elderly patients with medical comorbidities. The aim of the present study was to compare the outcomes between LLR and open liver resection (OLR) in elderly patients (≥65 years) with solitary, treatment-naïve solitary hepatocellular carcinoma (HCC). From January 2013 to August 2017, 256 elderly patients with solitary treatment-naive HCC underwent liver resection. All patients were Child–Pugh class A and older than 65 years. The OLR and LLR groups contained 160 and 96 patients, respectively. The median tumor size in the OLR group was significantly larger than that in the LLR group (3.9 vs. 2.6 cm), but the tumor size did not differ between the two groups after matching. The median operation time, blood loss, transfusion rate, and postoperative complications in the OLR group did not differ from those in the LLR group, but the operation time in the LLR group was longer than that in the OLR group after matching. The median hospitalization in the LLR group was significantly shorter than that in the OLR group. Disease-free survival (DFS) in the LLR group was better than that in the OLR group before and after matching, but the difference was not significant. Patient survival (PS) in the LLR group was similar to that in the OLR group. LLR is feasible and safe for elderly patients with solitary, treatment-naïve HCC. The short- and long-term benefits of LLR are evident in geriatric oncological liver surgery patients.

Laparoscopic hepatectomy for the treatment of pyogenic liver abscess: A retrospective case-control study

“…[ 11 , 12 , 20 ] In the treatment of malignant liver tumors, the curative effect of LH is equivalent to that of OH. [ 21 , 22 ] In our study, 61 patients with PLA of different causes and different locations underwent hepatectomy, of which 28 patients underwent LH, and 33 patients underwent OH. There was no significant difference in the operation time between the 2 groups, but the intraoperative blood loss, postoperative hospital stay, numerical rating scale, and overall postoperative complication rate in the LH group were significantly lower than those in the OH group.…”

Realization of improved outcomes following liver resection in hepatocellular carcinoma patients aged 75 years and older

“…The role of LLR techniques is to reduce the amount of surgical trauma and the degree of physiological disruption to patients. There have been numerous publications detailing the short-term benefits of LLR when applied to a general population [ 10 18 23 24 ]. Previous studies have reported an association between operative time and postoperative morbidity in LLR [ 25 ].…”

“…The choice between LLR or open LR (OLR) depended on the preferences of individual patients and their surgeons. The selection criteria for choosing the laparoscopic approach were surgeon-dependent and are described in a previous study [ 10 ]. The indication of OLR included tumor size of greater than 10 cm, except when the tumor was of the pedunculated type; reconstruction of vascular or biliary conduit; proximity to an important vital structure that is deemed difficult to dissect laparoscopically; and invasion to adjacent organs necessitating concomitant resection and reconstruction.…”

“…Each patient received standardized pre- and postoperative management according to the routine manual [ 10 ]. The preoperative evaluation of elderly patients included echocardiography and pulmonary function tests.…”

“…The general trend has been a shift away from conventional surgical procedures toward the laparoscopic approach. Recently, laparoscopic LR (LLR) has been accepted as feasible in the elderly [ 9 10 ].…”