Short-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma in older patients: a propensity score matching analysis

Abstract

Background The incidence of hepatocellular carcinoma (HCC) requiring surgical treatment in older patients has been continuously increasing. This study aimed to examine the safety and feasibility of performing laparoscopic liver resection (LLR) versus open liver resection (OLR) for HCC in older patients at a Japanese institution. Methods Between January 2010 and June 2021, 133 and 145 older patients (aged ≥ 70 years) who were diagnosed with HCC underwent LLR and OLR, respectively. Propensity score matching (PSM) analysis with covariates of baseline characteristics was performed. The intraoperative and postoperative data were evaluated in both groups. Results After PSM, 75 patients each for LLR and OLR were selected and the data compared. No significant differences in demographic characteristics, clinical data, and operative times were observed between the groups, although less than 10% of cases in each group underwent a major resection. Blood loss (OLR: 370 mL, LLR: 50 mL; P < 0.001) was lower, and the length of postoperative hospital stay (OLR: 12 days, LLR: 7 days; P < 0.001) and time to start of oral intake (OLR: 2 days, LLR: 1 day; P < 0.001) were shorter in the LLR group than in the OLR group. The incidence of complications ≥ Clavien–Dindo class IIIa was similar between the two groups. Conclusions LLR, especially minor resections, is safely performed and feasible for selected older patients with HCC.

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

“…The number of patients in each study ranged from a minimum of 51 to 438. Among the 12 included studies, four were performed in China ( 22 , 23 , 29 , 30 ), three in Japan ( 20 , 27 , 28 ), two in Korea ( 25 , 31 ), one in Singapore ( 26 ), one in France ( 21 ), and one study in Italy, France, and Spain ( 24 ), respectively. Different studies define “elder patients” individually.…”

“…Different studies define “elder patients” individually. Three studies ( 21 , 30 , 31 ) had an inclusion criterion of ≥65 years, eight studies ( 20 , 22 – 27 , 29 ) comprised patients aged ≥70 years, and one study ( 28 ) included patients who were 75 years old and above. The LLR and the OLR groups were comparable in terms of age, gender, characteristics of the tumor, and the American Society of Anesthesiologists score.…”

Liver resection, radiofrequency ablation, and radiofrequency ablation combined with transcatheter arterial chemoembolization for very-early- and early-stage hepatocellular carcinoma: A systematic review and Bayesian network meta-analysis for comparison of efficacy

“…Laparoscopic hepatectomy (LH) is considered safe and effective treatment for liver cancer. Studies have shown that LH has almost the same effect as traditional open surgery on HCC patients in terms of OS and RFS ( 44 , 45 ); moreover, it is associated with a lower complication rate, less intraoperative blood loss, and shorter hospital stay ( 46 , 47 ). Several recent studies comparing laparoscopic hepatectomy with percutaneous radiofrequency ablation have shown that LH is superior to percutaneous radiofrequency ablation for very-early- or early-stage HCC ( 28 , 30 , 48 ).…”

Clinical feasibility of combining intraoperative electron radiation therapy with minimally invasive surgery: a potential for electron-FLASH clinical development

“…Laparoscopic liver resection is an alternative approach to open surgery for hepatocellular carcinoma and metastatic liver disease [55]. Liver tolerance in large animal models to intraoperative electrons has a favorable profile and is an additional area of research and development for the electron-FLASH technology [56][57][58][59].…”