Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies

Abstract

PurposeLaparoscopic liver resection (LLR) is a widely practiced therapeutic method and holds several advantages over open liver resection (OLR) including less postoperative pain, lower morbidity, and faster recovery. However, the effect of LLR for the treatment of hepatocellular carcinoma (HCC) in elderly patients remains controversial. Therefore, we aimed to perform the first meta-analysis of propensity score-matched (PSM) studies to compare the short- and long-term outcomes of LLR versus OLR for elderly patients with HCC.MethodsDatabases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until April 2022 for eligible studies that compared LLR and OLR for the treatment of HCC in elderly patients. Short-term outcomes include postoperative complications, blood loss, surgical time, and length of hospital stay. Long-term outcomes include overall survival (OS) rate and disease-free survival (DFS) rate at 1, 3, and 5 years.ResultsA total of 12 trials involving 1,861 patients (907 in the LLR group, 954 in the OLR group) were included. Compared with OLR, LLR was associated with lower postoperative complications (OR 0.49, 95% CI 0.39 to 0.62, P < 0.00001, I2 = 0%), less blood loss (MD −285.69, 95% CI −481.72 to −89.65, P = 0.004, I2 = 96%), and shorter hospital stay (MD −7.88, 95% CI −11.38 to −4.37, P < 0.0001, I2 = 96%), whereas operation time (MD 17.33, 95% CI −6.17 to 40.83, P = 0.15, I2 = 92%) was insignificantly different. Furthermore, there were no significant differences for the OS and DFS rates at 1, 3, and 5 years.ConclusionsFor elderly patients with HCC, LLR offers better short-term outcomes including a lower incidence of postoperative complications and shorter hospital stays, with comparable long-term outcomes when compared with the open approach. Our results support the implementation of LLR for the treatment of HCC in elderly patients.Systematic review registrationhttps://inplasy.com/inplasy-2022-4-0156/, identifier INPLASY202240156.

Comparing laparoscopic and open resection in elderly hepatocellular carcinoma: a systematic review and meta-analysis

“…Our analysis indicated that there was no significant difference in long-term survival between the two surgical approaches. These findings align with those of previous studies ( 9 - 11 ). However, it is important to note that further research is necessary to provide more detailed survival data and adjusted HR as time-to-event data, which can enhance the precision and depth of our understanding in this context.…”

“…We excluded studies with mixed populations, encompassing patients under 65 years of age or those with other liver malignancies like intrahepatic cholangiocarcinoma, liver metastases, or recurrent liver cancer. Previously, Jiang et al ( 10 ) conducted a review and meta-analysis encompassing 14 studies comparing laparoscopic hepatectomy to open hepatectomy, while Wang et al ( 9 ) performed meta-analyses using 12 propensity score-matched studies. Brolese et al ( 11 ) reviewed eight studies comparing minimally invasive LRs (laparoscopic or robotic) to OLR.…”

“…The choice of treatment depends on factors such as the disease stage, extent, and the patient’s overall health ( 4 , 5 ). Among these options, surgical resection has emerged as a primary curative strategy for HCC, offering the potential for long-term survival and disease control ( 6 - 9 ). In the context of an aging population, a critical question arises: “What is the most effective and safest surgical approach for hepatocellular carcinoma in elderly patients?”…”

“…Two prominent surgical techniques for HCC resection are laparoscopic liver resection (LLR) and open liver resection (OLR). LLR, a minimally invasive surgery, has gained popularity over the last two decades due to its potential advantages, including reduced postoperative pain, shorter hospital stays, and faster recovery ( 9 - 11 ). In contrast, OLR represents the conventional surgical approach, affording the surgeon a direct and tactile perception of the liver, which allows for better control of bleeding and potential complications ( 12 ).…”

What Is the Role of Minimally Invasive Liver Surgery in Treating Patients with Hepatocellular Carcinoma on Cirrhosis?

“…The question of whether minimally invasive liver surgery (MILS) improves post-resection outcomes for HCC is a topic that has garnered considerable attention in the literature. Numerous studies provide substantial evidence supporting the significant advantages of MILS in enhancing short-term surgical outcomes for patients undergoing HCC resection when compared to the traditional open technique, particularly in high-volume centers [ 40 , 41 , 42 , 43 , 44 , 45 ]. Both laparoscopic and robotic techniques have demonstrated their efficacy in reducing the risk of post-hepatectomy liver failure and mitigating postoperative complications [ 46 , 47 ].…”