Antonella Delvecchio1, Maria Conticchio1, Francesca Ratti2, Maximiliano Gelli3,4, Ferdinando Massimiliano Anelli5, Alexis Laurent6, Giulio Cesare Vitali7, Paolo Magistri8, Giacomo Assirati8, Emanuele Felli9, Taiga Wakabayashi9, Patrick Pessaux9, Tullio Piardi10,11, Fabrizio Di Benedetto8, Nicola de'Angelis6, Javier Briceño-Delgado5, Rene Adam4, Daniel Cherqui4, Luca Aldrighetti2, Riccardo Memeo12. 1. General Surgery, University Hospital Policlinico of Bari, Bari, Italy. 2. Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy. 3. Department of Surgical Oncology, Institute of Oncology Gustave Roussy, Villejuif, France. 4. Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France. 5. Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain. 6. Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France. 7. Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. 8. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. 9. Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France. 10. Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France. 11. Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France. 12. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy. info@drmemeoriccardo.com.
Abstract
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.
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.
Entities:
Keywords:
Elderly; Hepatocellular carcinoma; Laparoscopy; Liver cirrhosis; Major hepatectomy
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