Minimally invasive hepatectomy is associated with decreased morbidity and resource utilization in the elderly

Tee, May C.; Chen, Leo; Peightal, Devon; Franko, Jan; Kim, Peter T; Brahmbhatt, Rushin D.; Raman, Shankar; Scudamore, Charles H.; Chung, Stephen W.; Segedi, Maja

doi:10.1007/s00464-019-07298-5

Cited by 21 publications

(20 citation statements)

References 19 publications

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“…The 29 remaining studies were assessed for eligibility by a full-text examination. Finally, eight studies [18][19][20][21][22][23][24][25] were included in this systematic review for the quantitative synthesis, five of which compared laparoscopic liver resection and open approach, two robotic vs. open liver resection and one both laparoscopic and robotic vs. open approach [ Table 1].…”

Section: Study Characteristics and Populationmentioning

confidence: 99%

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Brolese¹,

Rigoni²,

Vitale³

et al. 2020

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Section: Study Characteristics and Populationmentioning

confidence: 99%

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Brolese¹,

Rigoni²,

Vitale³

et al. 2020

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

Section: Introductionmentioning

confidence: 99%

Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Kim

Rhu

et al. 2020

Cancers

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It remains unclear whether the short-term benefits and long-term outcomes of laparoscopic liver resection (LLR) accrue to elderly patients with medical comorbidities. The aim of the present study was to compare the outcomes between LLR and open liver resection (OLR) in elderly patients (≥65 years) with solitary, treatment-naïve solitary hepatocellular carcinoma (HCC). From January 2013 to August 2017, 256 elderly patients with solitary treatment-naive HCC underwent liver resection. All patients were Child–Pugh class A and older than 65 years. The OLR and LLR groups contained 160 and 96 patients, respectively. The median tumor size in the OLR group was significantly larger than that in the LLR group (3.9 vs. 2.6 cm), but the tumor size did not differ between the two groups after matching. The median operation time, blood loss, transfusion rate, and postoperative complications in the OLR group did not differ from those in the LLR group, but the operation time in the LLR group was longer than that in the OLR group after matching. The median hospitalization in the LLR group was significantly shorter than that in the OLR group. Disease-free survival (DFS) in the LLR group was better than that in the OLR group before and after matching, but the difference was not significant. Patient survival (PS) in the LLR group was similar to that in the OLR group. LLR is feasible and safe for elderly patients with solitary, treatment-naïve HCC. The short- and long-term benefits of LLR are evident in geriatric oncological liver surgery patients.

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“…Observational studies and meta-analysis showed that laparoscopy decreased intraoperative bleeding, postoperative complications, and length of hospital stay when compared with OLRs [ 2 , 3 ]. Recently, robotic-assisted surgery has been described as an alternative to laparoscopy for MILRs, with equivalent results for both short and long-term outcomes [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

et al. 2020

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Background Minimally invasive liver resections (MILRs) have been increasingly performed in recent years. However, the majority of MILRs are actually minor or limited resections of peripheral lesions. Due to the technical complexity major hepatectomies remain challenging for minimally invasive surgery. The aim of this study was to compare the short and long-term outcomes of patients undergoing minimally invasive right hepatectomies (MIRHs) with contemporary patients undergoing open right hepatectomies (ORHs) Methods Consecutive patients submitted to anatomic right hepatectomies between January 2013 and December 2018 in two tertiary referral centers were studied. Study groups were compared on an intention-to-treat basis after propensity score matching (PSM). Overall survival (OS) analyses were performed for the entire cohort and specific etiologies subgroups Results During study period 178 right hepatectomies were performed. After matching, 37 patients were included in MIRH group and 60 in ORH group. The groups were homogenous for all baseline characteristics. MIRHs had significant lower blood loss (400 ml vs. 500 ml, P = 0.01), lower rate of minor complications (13.5% vs. 35%, P = 0.03) and larger resection margins (10 mm vs. 5 mm, P = 0.03) when compared to ORHs. Additionally, a non-significant decrease in hospital stay (ORH 9 days vs. MIRH 7 days, P = 0.09) was observed. No differences regarding the use of Pringle’s maneuver, operative time, overall morbidity or perioperative mortality were observed. OS was similar between the groups (P = 0.13). Similarly, no difference in OS was found in subgroups of patients with primary liver tumors (P = 0.09) and liver metastasis (P = 0.80). Conclusions MIRHs are feasible and safe in experienced hands. Minimally invasive approach was associated with less blood loss, a significant reduction in minor perioperative complications, and did not negatively affect long-term outcomes.

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Minimally invasive hepatectomy is associated with decreased morbidity and resource utilization in the elderly

Cited by 21 publications

References 19 publications

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Minimally invasive versus open right hepatectomy: comparative study with propensity score matching analysis

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