Nicole Hildebrand1, Koen Verkoulen2, Maxime Dewulf2, Daniel Heise3, Florian Ulmer3, Marielle Coolsen4. 1. Department of Surgery, Maastricht University Medical Centre, the Netherlands. Electronic address: nicole.hildebrand@mumc.nl. 2. Department of Surgery, Maastricht University Medical Centre, the Netherlands. 3. Department of General-, Visceral-, and Transplant Surgery, Uniklinikum Aachen, Germany. 4. Department of Surgery, Maastricht University Medical Centre, the Netherlands; Department of General-, Visceral-, and Transplant Surgery, Uniklinikum Aachen, Germany.
Abstract
BACKGROUND AND AIM: Favorable outcomes of laparoscopic hepatectomy (LH) over open hepatectomy (OH) have been demonstrated. LH offers less postoperative morbidity, less blood loss, and shorter hospital stay, while maintaining oncological safety. Only limited evidence about outcomes of LH in elderly is currently available. Therefore, this study aimed to compare short term outcomes of LH to OH for patients >65 years. METHODS: A systematic review and meta-analysis were performed according to Cochrane guidelines. Embase, PubMed, Cochrane Library, and Google Scholar were searched to identify eligible studies. Studies were included if they compared LH to OH, and focused on an elderly population, or had a majority of patients >65 years. Perioperative and postoperative outcomes were analyzed. RESULTS: Thirteen studies with 1174 patients (LH:532, OH:642) were included for analysis. When compared to OH, elderly undergoing LH had significantly less postoperative complications (risk ratio [RR]0.52; 95% confidence interval (CI):0.43-0.63), less blood loss (mean difference [MD]-198.58; 95% CI:-299.88 to -97.28), and shorter length of stay (MD-4.83; 95%CI:-7.91 to -1.84), while oncological safety was non-inferior (RR1.04; 95%CI:1.00-1.08). CONCLUSIONS: Within the elderly population LH seems to be superior to OH, concerning short-term outcomes. However, for broader applicability more trials are needed including more difficult and major resections.
BACKGROUND AND AIM: Favorable outcomes of laparoscopic hepatectomy (LH) over open hepatectomy (OH) have been demonstrated. LH offers less postoperative morbidity, less blood loss, and shorter hospital stay, while maintaining oncological safety. Only limited evidence about outcomes of LH in elderly is currently available. Therefore, this study aimed to compare short term outcomes of LH to OH for patients >65 years. METHODS: A systematic review and meta-analysis were performed according to Cochrane guidelines. Embase, PubMed, Cochrane Library, and Google Scholar were searched to identify eligible studies. Studies were included if they compared LH to OH, and focused on an elderly population, or had a majority of patients >65 years. Perioperative and postoperative outcomes were analyzed. RESULTS: Thirteen studies with 1174 patients (LH:532, OH:642) were included for analysis. When compared to OH, elderly undergoing LH had significantly less postoperative complications (risk ratio [RR]0.52; 95% confidence interval (CI):0.43-0.63), less blood loss (mean difference [MD]-198.58; 95% CI:-299.88 to -97.28), and shorter length of stay (MD-4.83; 95%CI:-7.91 to -1.84), while oncological safety was non-inferior (RR1.04; 95%CI:1.00-1.08). CONCLUSIONS: Within the elderly population LH seems to be superior to OH, concerning short-term outcomes. However, for broader applicability more trials are needed including more difficult and major resections.
Authors: Adrian K H Chiow; David Fuks; Gi-Hong Choi; Nicholas Syn; Iswanto Sucandy; Marco V Marino; Mikel Prieto; Charing C Chong; Jae Hoon Lee; Mikhail Efanov; T Peter Kingham; Sung Hoon Choi; Robert P Sutcliffe; Roberto I Troisi; Johann Pratschke; Tan-To Cheung; Xiaoying Wang; Rong Liu; Mathieu D'Hondt; Chung-Yip Chan; Chung Ngai Tang; Ho-Seong Han; Brian K P Goh Journal: Br J Surg Date: 2021-12-01 Impact factor: 6.939
Authors: Wang Jianxi; Zou Xiongfeng; Zheng Zehao; Zhao Zhen; Peng Tianyi; Lin Ye; Jin Haosheng; Jian Zhixiang; Wang Huiling Journal: Front Oncol Date: 2022-07-19 Impact factor: 5.738