A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation

Yazici, Pınar; Akyüz, Muhammet; Yiğitbaş, Hakan; Dural, Ahmet Cem; Okoh, Alexis K.; Aydin, Nail; Berber, Eren

doi:10.1007/s00464-016-5105-5

Cited by 23 publications

(13 citation statements)

References 36 publications

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“…The long-term effect is the major controversy on laparoscopic liver resection for liver malignancies and many retrospective or casematched studies had been carried out (36)(37)(38)(39)(40)(41)(42). According to current experience, there is no difference of survival time between laparoscopic liver resection and open liver resection, but the final conclusion should base on data from multi-center and randomized case-controlled clinical trials.…”

Section: Outcomes Of Laparoscopic Liver Resectionmentioning

confidence: 99%

Laparoscopic liver resection: the current status and the future

Cai

2018

Hepatobiliary Surg. Nutr.

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Section: Outcomes Of Laparoscopic Liver Resectionmentioning

confidence: 99%

Laparoscopic liver resection: the current status and the future

Cai

2018

Hepatobiliary Surg. Nutr.

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“…First, with advanced surgical techniques and better perioperative management, SR (open or laparoscopic) can be tolerated as well as RFA in majority of elderly patients with similar postoperative comorbidities, and laparoscopic resection has been suggested to be considered as an option in selected elderly patients who are deemed poor candidates for open hepatectomy. [ 11 23 ] Besides, significant advantages of SR over RFA are mainly attributable to the removal of potential venous tumor thrombi and complete eradication of the primary tumor with clean resection margins by SR,[ 24 ] while RFA is restricted by the limitation of ablation volume and non-histological confirmation of the ablative margin. [ 10 25 26 ] Previous studies have reported that RFA is unable to produce a sufficiently high temperature in all areas of tumor if the nodule is larger than 4 cm in diameter and that the maximum tumor size under optimal conditions is 3 cm to achieve a 1-cm ablative margin.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage

Ding

Liao

et al. 2018

Saudi J Gastroenterol

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Background/Aims:To compare the survival benefits of surgical resection (SR) with those of radiofrequency ablation (RFA) in elderly patients (≥65 years) with single hepatocellular carcinoma (HCC) ≤5 cm.Patients and Methods:Using the Surveillance, Epidemiology, and End Results database, a total of 461 patients who underwent SR and 575 patients who underwent RFA were enrolled from 2004 to 2012. Overall survival (OS) and liver-cancer-specific survival (LCSS) comparisons were conducted between the two groups before and after propensity score matching (PSM).Results:Elderly patients with early-stage HCC had a lower rate of utilization of liver transplantation, and they were more likely to receive SR or RFA as their first-line treatment compared with younger patients (P < 0.05). In the whole cohort, the SR group had significantly better OS [RFA, hazard ratio (HR) = 1.680 (1.390, 2.031), P < 0.001] and LCSS (RFA, HR = 1.658 (1.327, 2.070), P < 0.001) than the RFA group. After PSM, the improved survival in the SR group was further confirmed (all P < 0.001). In the subgroup analyses, according to patients' age (65–75, >75 years) and tumor size (≤3.0, 3.1–5.0 cm), the SR group still presented better OS and LCSS than the RFA group (all P < 0.05), except for those older than 75 years with tumors ≤3.0 cm (all P > 0.05), both before and after PSM.Conclusion:Treatment strategies for elderly patients (≥65 years) with single HCC ≤5 cm should emphasize SR as the primary therapy, while RFA can be an alternative to SR for those >75 years with single HCC ≤3 cm.

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“…Considering these data, surgeons could probably exclude a case with multiple comorbidities, whether intentionally or unintentionally, and select a less invasive operative procedure in patients aged over 80 years. Indeed, a recent study by Yazit et al [23] reported the safety of laparoscopic hepatectomy in selected elderly patients with less local treatment failure. In addition, Cauchy et al [24] demonstrated that the laparoscopic approach was significantly associated with good postoperative outcomes compared with laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes following Hepatectomy in Elderly Patients with Hepatocellular Carcinoma: An Analysis of 10,805 Septuagenarians and 2,381 Octo- and Nonagenarians in Japan

et al. 2017

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Background: As the population is aging, the indication for hepatocellular carcinoma (HCC) resection in patients aged over 80 years will increase. Japan is facing the most aging society worldwide. We examined the safety of hepatectomy in octogenarians and nonagenarians using large-scale data from the Diagnosis Procedure Combination database, a national administrative database in Japan. Method: We conducted a survey to collect data for all inpatients from 2007 and 2012. We identified 27,094 patients who underwent hepatectomy for HCC. Patients' age was divided into the following five categories: ≤59, 60-69, 70-79, 80-84, and ≥85 years (n = 5,099, 8,809, 10,805, 2,011, and 370, respectively). The primary outcomes of hepatectomy were in-hospital death within 90 days and complications. Logistic regression analyses were performed to analyze the impact of age on the outcomes with the adjustment of other individual-level factors. Results: The mortality and morbidity rates were 2.6 and 23.4%, respectively. Compared with patients in their 70s, the mortality rate was significantly lower in patients aged ≤59 years (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.26-0.45; p < 0.01) and in those in their 60s (OR, 0.63; 95% CI, 0.53-0.74; p < 0.01). However, no significant difference was observed in patients aged 80-84 years (OR, 1.03; 95% CI, 0.78-1.385; p = 0.844) and those aged ≥85 years (OR, 0.95; 95% CI, 0.50-1.79; p = 0.870). Based on the multivariate logistic regression analysis, age ≥70 years, male gender, low hospital volume, and surgical procedure were identified as independent predictors of mortality. Conclusions: The operative risk for hepatectomy gradually increases with age until patients are in their 70s, and it appears to reach a plateau among septuagenarian. Indeed, age over 70 years can also be a risk factor for HCC. By considering the aging risk, surgeons can attain good outcome after hepatectomy even in octo- and nonagenarian patients.

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A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation

Abstract: This study showed that LLR was tolerated as well as LRFA in elderly patients with similar comorbidities. We suggest LLR to be considered as an option in selected elderly patients who are deemed poor candidates for open hepatectomy.

Cited by 23 publications

References 36 publications

Laparoscopic liver resection: the current status and the future

Laparoscopic liver resection: the current status and the future

Radiofrequency ablation versus surgical resection in elderly patients with early-stage hepatocellular carcinoma in the era of organ shortage

Short-Term Outcomes following Hepatectomy in Elderly Patients with Hepatocellular Carcinoma: An Analysis of 10,805 Septuagenarians and 2,381 Octo- and Nonagenarians in Japan

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