François Cauchy1, David Fuks2, Takeo Nomi3, Safi Dokmak4, Olivier Scatton5, Lilian Schwarz6, Louise Barbier7, Jacques Belghiti7, Olivier Soubrane1, Brice Gayet3. 1. Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France. 2. Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France; Department of Digestive Disease, Institut Mutualiste Montsouris, University René Descartes, Paris, France. Electronic address: davidfuks80@gmail.com. 3. Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France; Department of Digestive Disease, Institut Mutualiste Montsouris, University René Descartes, Paris, France. 4. Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France. 5. Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, Paris, France. 6. Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France. 7. Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
Abstract
BACKGROUND: Although recent reports have suggested the potential advantages of laparoscopy in patients undergoing major hepatectomy, the benefits of this approach in elderly patients remain unclear. This study aimed to compare the short-term outcomes of laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients. STUDY DESIGN: All patients aged 55 years and older undergoing laparoscopic LMH between 2000 and 2013 at 2 centers were retrospectively analyzed and divided into 3 groups (group 1: 55 to 64 years old; group 2: 65 to 74 years old; and group 3: 75 years and older). Risk factors for postoperative complications were determined on multivariable analysis in the overall LMH population and in each LMH group. Outcomes of LMH patients were compared with those of patients of similar age undergoing OMH at another center after propensity score matching. RESULTS: Laparoscopic major hepatectomy was performed in 174 patients, including 72 (41.4%) in group 1, 67 (38.5%) in group 2, and 35 (20.1%) in group 3. On multivariable analysis, diabetes (odds ratio [OR] = 2.349; 95% CI, 1.251-2.674; p = 0.047), American Society of Anesthesiologists status (OR = 2.881; 95% CI, 2.193-3.71; p = 0.017), cirrhosis (OR = 1.426; 95% CI, 1.092-2.025; p = 0.043), right-sided resection (OR = 2.001; 95% CI, 1.492-2.563; p = 0.037), conversion (OR = 1.950; 95% CI, 1.331-2.545; p = 0.024), and intraoperative transfusion (OR = 2.338, 95% CI, 1.738-2.701, p = 0.032) were associated with increased risk of postoperative complications in the whole LMH population. After propensity score matching, laparoscopy was associated with significantly decreased rates of pulmonary complications and shorter hospital stays in all groups, decreased rates of overall complications in group 2 and group 3, and decreased rates of postoperative confusion in group 3. CONCLUSIONS: The current study supports the benefits of laparoscopy in decreasing postoperative complications in elderly patients requiring major hepatectomy.
BACKGROUND: Although recent reports have suggested the potential advantages of laparoscopy in patients undergoing major hepatectomy, the benefits of this approach in elderly patients remain unclear. This study aimed to compare the short-term outcomes of laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients. STUDY DESIGN: All patients aged 55 years and older undergoing laparoscopic LMH between 2000 and 2013 at 2 centers were retrospectively analyzed and divided into 3 groups (group 1: 55 to 64 years old; group 2: 65 to 74 years old; and group 3: 75 years and older). Risk factors for postoperative complications were determined on multivariable analysis in the overall LMH population and in each LMH group. Outcomes of LMHpatients were compared with those of patients of similar age undergoing OMH at another center after propensity score matching. RESULTS: Laparoscopic major hepatectomy was performed in 174 patients, including 72 (41.4%) in group 1, 67 (38.5%) in group 2, and 35 (20.1%) in group 3. On multivariable analysis, diabetes (odds ratio [OR] = 2.349; 95% CI, 1.251-2.674; p = 0.047), American Society of Anesthesiologists status (OR = 2.881; 95% CI, 2.193-3.71; p = 0.017), cirrhosis (OR = 1.426; 95% CI, 1.092-2.025; p = 0.043), right-sided resection (OR = 2.001; 95% CI, 1.492-2.563; p = 0.037), conversion (OR = 1.950; 95% CI, 1.331-2.545; p = 0.024), and intraoperative transfusion (OR = 2.338, 95% CI, 1.738-2.701, p = 0.032) were associated with increased risk of postoperative complications in the whole LMH population. After propensity score matching, laparoscopy was associated with significantly decreased rates of pulmonary complications and shorter hospital stays in all groups, decreased rates of overall complications in group 2 and group 3, and decreased rates of postoperative confusion in group 3. CONCLUSIONS: The current study supports the benefits of laparoscopy in decreasing postoperative complications in elderly patients requiring major hepatectomy.
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