Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Geriatric Oncology

Background:

• The efficacy of laparoscopic liver resection (LLR) versus open liver resection (OLR) in elderly patients with hepatocellular carcinoma (HCC) remains under investigation.
• Elderly patients often present with medical comorbidities, complicating surgical decisions.

Purpose of the Study:

• To compare the short-term and long-term outcomes of LLR and OLR in elderly patients (≥65 years) with solitary, treatment-naïve HCC.
• To evaluate the safety and feasibility of LLR in this specific patient population.

Main Methods:

• A retrospective study of 256 elderly patients (Child-Pugh class A) with solitary, treatment-naïve HCC who underwent either LLR (96 patients) or OLR (160 patients) between January 2013 and August 2017.
• Patient outcomes, including operation time, blood loss, transfusion rates, postoperative complications, hospitalization duration, disease-free survival (DFS), and patient survival (PS), were analyzed.
• Propensity score matching was used to control for differences in tumor size between the groups.

Main Results:

• While the median tumor size was larger in the OLR group initially, it was comparable after matching. Operation time was longer in the LLR group post-matching.
• The LLR group demonstrated significantly shorter hospitalization durations compared to the OLR group.
• Disease-free survival showed a trend towards improvement in the LLR group, though not statistically significant. Patient survival was similar between both groups.

Conclusions:

• Laparoscopic liver resection (LLR) is a feasible and safe surgical option for elderly patients diagnosed with solitary, treatment-naïve hepatocellular carcinoma (HCC).
• The study suggests that LLR provides both short- and long-term advantages for geriatric patients undergoing liver surgery.