Laparoscopic hepatectomy for HCC in elderly patients: risks and feasibility

Amato, Bruno; Aprea, Giovanni; Rosa, Davide De; Milone, Marco; Domenico, Lorenza Di; Amato, Maurizio; Compagna, Rita; Santoro, M Giannotti; Johnson, Louis Banka; Sanguinetti, Alessandro; Polistena, Andrea; Avenia, Nicola

doi:10.1007/s40520-016-0675-6

Cited by 27 publications

(42 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The characteristics of a total of 5100 patients from 43 studies included in the meta-analysis are specified in Table 1 [ 27 – 69 ]. The only randomized controlled trial was conducted by Jiang et al [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients

et al. 2018

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…[ 19 , 22 – 24 , 26 ] Five studies used 70 years as the age cutoff the elderly label, [ 18 , 19 , 22 , 23 , 26 ] whereas 1 study used 65 years [ 24 ] and the other 3 studies used 75. [ 20 , 21 , 25 ] The indications of 2 studies included benign liver lesions and malignancy. [ 20 , 21 ] The indications of the remaining 7 studies were reported as malignant, with colorectal metastases the most frequently recorded.…”

Section: Resultsmentioning

confidence: 99%

“…One study was only restricted to primary hepatocellular carcinoma. [ 25 ] The majority type of intervention was total or pure laparoscopic hepatic resection, but 1 study used hand-assisted or hybrid procedures. [ 20 ] All of the included studies graded morbidity according to the Clavien-Dindo Classification.…”

Section: Resultsmentioning

confidence: 99%

“…[ 20 ] All of the included studies graded morbidity according to the Clavien-Dindo Classification. The definition of mortality was 90 days in 5 studies, which included perioperative death cases, [ 18 , 19 , 21 , 25 , 26 ] and 1 study used 30-day mortality. [ 24 ] Four studies reported mid- or long-term postoperative survival results.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, accurate vascular control further reducing the volume of intraoperative blood loss with less disruption of homeostatic regulation. As for OH, the Pringle maneuver and intravenous fluid restriction can also be used for LH, as required, [ 21 , 23 , 25 ] which is especially effective in controlling bleeding and providing a clear surgical view under laparoscopy. The decrease in blood loss with LH, compared to OH, results in a steady hemodynamic alteration and, thus, a lower rate of transfusion for LH than OH (RR = 0.61).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic hepatectomy for elderly patients

et al. 2018

View full text Add to dashboard Cite

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.

show abstract