Laparoscopic hepatectomy for elderly patients

Abstract

Background:As the general population continues to age, there is an increase need for surgical management of elderly patients. Compared to open hepatectomy (OH), laparoscopic hepatectomy (LH) offers earlier mobilization, less blood loss, and shorter postoperative hospital stay. However, whether these advantages of LH over OH are retained in elderly patients remains to be clarified. Therefore, in this study, we sought to evaluate the feasibility, safety, and potential benefits of LH for elderly patients.Methods:A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared LH and OH. Studies comparing LH in elderly and LH in nonelderly patients were also identified. Outcomes of interest included conversion rate, operative time, intraoperative estimated blood loss, length of hospital stay, rate and type of morbidity, mortality rate, margin status (R0), and long-term oncologic outcomes.Results:Nine studies met our inclusion criteria for this analysis. Of these, 5 compared LH and OH in elderly patients, 3 compared LH in elderly and nonelderly patients, and 1 included both outcomes. Compared to those with OH, elderly patients who underwent LH had similar operative times [weighted mean difference (WMD) = 1.15 minutes; 95% confidence interval (CI): −28.28–30.59, P = .94], less intraoperative blood loss (WMD = −0.71 mL; 95% CI: −1.29 to −0.16, P = .01), a lower rate of transfusion [risk ratio (RR) = 0.61, 95% CI: 0.40–0.94, P = .02], comparable R0 rates (RR = 1.01; 95% CI: 0.96–1.07, P = .70), less postoperative complications (RR = 0.61, 95% CI: 0.48–0.76, P < .01), and shorter hospital stay (WMD = −3.22 days; 95% CI: −4.21 to −2.23, P < .01). The limited long-term outcomes indicated that survival status was comparable between LH and OH for elderly patients. The pooled outcomes for elderly versus nonelderly patients indicated that the safety and effectiveness of LH over OH in elderly patients was not inferior to those in nonelderly patients.Conclusion:Our results indicate that LH is a feasible and safe alternative to OH in elderly patients, providing a lower rate of morbidity and favorable postoperative recovery and outcomes.

Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

“…Interestingly, DFS in the LLR group was better than that in the OLR group even after matching. A previous study showed that worse basic disease conditions and ASA grades predicted poor clinical outcomes [15]; however, those factors had little effect on HCC recurrence or overall survival in our study. We did not identify a significant difference in the survival rate between the OLR and LLR groups.…”

“…Our elderly patients had a 90-day postoperative mortality rate of less than 1%, which could be associated with the decreased blood loss and decreased surgical wall trauma that occurs with the laparoscopic approach. Previous studies reported that liver resection in the elderly via the open approach had a very high mortality rate ranging from 3.5 to 5.6% [15]. Although the difference in the rate of 90-day postoperative mortality between LLR and OLR was not statistically significant, we did identify a trend favoring LLR, which we attribute to its smaller surgical incision, which would reduce exposure to bacteria and thereby decrease incisional complications.…”

“…[9][10][11]. However, little is known about the effectiveness of LLR compared to OLR in elderly HCC patients [14,15].…”

Anesthetic management of geriatric patients

“…A 2019 meta-analysis showed that postoperative morbidity and mortality increased with age [65]. However, a 2018 meta-analysis showed that laparoscopic hepatectomy is a feasible and safe alternative to open hepatectomy in elderly patients because of the lower rates of morbidity and favorable postoperative recovery and outcomes [66]. Another 2018 meta-analysis showed that the outcomes of laparoscopic gastrectomy for elderly gastric cancer patients were comparable to those in nonelderly patients.…”

The circRNA_102911/miR‑129‑5p/SOX6 axis is involved with T lymphocyte immune function in elderly patients with laparoscopic left hepatectomy for hepatolithiasis

“…As the development of laparoscopic technology and the update of laparoscopic instruments, laparoscopic hepatectomy is considered to be a more favorable option for the treatment of hepatolithiasis compared with open hepatectomy ( 1 ). Compared to conventional open approaches, the laparoscopic approach has been shown to cause reduced intraoperative blood loss, fewer post-operative complications, a shorter hospital stay and a shorter intestinal function recovery time, even in elderly patients ( 2 ). However, for surgeons, a high infective complication rate in elderly patients is still a substantial challenge, even when using minimally invasive techniques such as laparoscopic hepatectomy, which results in mild trauma to patients ( 3 ).…”