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Published on: December 4, 2023
Laparoscopic major hepatectomy for hepatocellular carcinoma in elderly patients: a multicentric propensity
Antonella Delvecchio1, Maria Conticchio1, Francesca Ratti2
1General Surgery, University Hospital Policlinico of Bari, Bari, Italy.
Insights
Laparoscopic major hepatectomy (LMH) offers better short-term outcomes for elderly hepatocellular carcinoma (HCC) patients compared to open surgery. This approach is safe and feasible for this demographic, with comparable long-term survival.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Geriatric surgery
Background:
- Increasing life expectancy leads to more elderly patients with hepatocellular carcinoma (HCC).
- Major hepatectomy is traditionally contraindicated in the elderly due to comorbidities.
- Limited data exists on surgical outcomes for elderly HCC patients undergoing major liver resection.
Purpose of the Study:
- To compare short-term and long-term outcomes of laparoscopic major hepatectomy (LMH) versus open major hepatectomy (OMH) in elderly HCC patients.
- To evaluate the safety and feasibility of LMH in patients aged 70 years and above.
Main Methods:
- Multicenter retrospective study of 184 elderly HCC patients undergoing major liver resection.
- Propensity score matching (PSM) was used to create comparable groups for LMH and OMH.
- Comparison of perioperative complications, hospital stay, 90-day mortality, overall survival (OS), and disease-free survival (DFS).
Main Results:
- After PSM, 122 patients (38 LMH, 84 OMH) were analyzed.
- LMH group showed significantly lower postoperative complications (18% vs. 46%, p<0.001) and shorter hospital stays (5 vs. 7 days, p=0.01).
- No significant difference in 90-day mortality, OS, or DFS at 1, 3, and 5 years between LMH and OMH groups.
Conclusions:
- Laparoscopic major hepatectomy (LMH) demonstrates favorable short-term outcomes in elderly patients (≥70 years) with HCC compared to open major hepatectomy (OMH).
- LMH is a safe and feasible surgical option for this patient population.
- The study supports the adoption of LMH for elderly HCC patients, offering improved recovery without compromising long-term survival.
Background:
Considering the increase in overall life expectancy and the rising incidence of hepatocellular carcinoma (HCC), more elderly patients are considered for hepatic resection. Traditionally, major hepatectomy has not been proposed to the elderly due to severe comorbidities. Indeed, only a few case series are reported in the literature. The present study aimed to compare short-term and long-term outcomes between laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients with HCC using propensity score matching (PSM).
Methods:
We performed a multicentric retrospective study including 184 consecutive cases of HCC major liver resection in patients aged ≥ 70 years in _8 European Hospital Centers. Patients were divided into LMH and OMH groups, and perioperative and long-term outcomes were compared between the 2 groups.
Results:
After propensity score matching, 122 patients were enrolled, 38 in the LMH group and 84 in the OMH group. Postoperative overall complications were lower in the LMH than in the OMH group (18 vs. 46%, p < 0.001). Hospital stay was shorter in the LMH group than in the OMH group (5 vs. 7 days, p = 0.01). Mortality at 90 days was comparable between the two groups. There were no significant differences between the two groups in terms of overall survival (OS) and disease-free survival (DFS) at 1, 3, and 5 years.
Conclusion:
LMH for HCC is associated with appropriate short-term outcomes in patients aged ≥ 70 years as compared to OMH. LMH is safe and feasible in elderly patients with HCC.
