1General Surgery, University Hospital Policlinico of Bari, Bari, Italy.
2Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy.
3Department of Surgical Oncology, Institute of Oncology Gustave Roussy, Villejuif, France.
4Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France.
5Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain.
6Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France.
7Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
8Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.
9Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France.
10Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France.
11Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France.
12Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy. firstname.lastname@example.org.
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.