Defining the role of laparoscopic liver resection in elderly HCC patients - a propensity score matched analysis

Abstract

Aim: To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma (HCC).Methods: A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018. Consecutive HCC patients aged 65 or above at the time of operation were recruited. Patients with recurrent HCC and/or alternative pathology were excluded. Short-term and long-term outcomes between the laparoscopic and the open group were compared. Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.Results: A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018. Among them, 320 elderly patients aged over 65 years old were eligible for analysis. Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level, aspartate transaminase, and magnitude of hepatectomy (major vs. minor). After propensity score matching of 1:2, 46 patients in the laparoscopic group and 92 patients in the open group were included for comparison. The laparoscopic group had less blood loss (326 mL vs. 735 mL; P < 0.001), shorter operative time (223 min vs. 324 min; P < 0.001), and shorter hospital stay (6.3 days vs. 10.5 days; P < 0.001). No significant differences in postoperative morbidity and hospital mortality were noted between the groups. For oncological outcome, the laparoscopic group had a superior disease-free survival (59.7% vs. 44.5%; P = 0.041), and a trend towards better overall survival compared with the open group. (78.4% vs. 64.8%; P = 0.110). Conclusion:Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.