Top

Surgical Endoscopy

Published in:

01-03-2017

A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation

Authors: Pinar Yazici, Muhammet Akyuz, Hakan Yigitbas, Cem Dural, Alexis Okoh, Nail Aydin, Eren Berber

Published in: Surgical Endoscopy | Issue 3/2017

Abstract

Background

Liver resection is the treatment option with the best chance for cure in patients with malignant liver tumors. However, there are concerns regarding postoperative recovery in elderly patients, which may lead to a preference of non-resectional therapies over hepatectomy in this patient population. Although laparoscopic liver resection (LLR) is associated with a faster recovery compared to open hepatectomy, there are scant data on how elderly patients tolerate LLR. The aim of this study was to analyze the perioperative outcomes of LLR in elderly patients with hepatic malignancies, with a comparison to laparoscopic RFA (LRFA).

Methods

A retrospective analysis of a prospective database for liver tumors identified a total of 82 patients older than 65 years who underwent laparoscopic treatment of their liver tumors in a single tertiary care center between 2000 and 2014. These patients were equally distributed into LLR and LRFA treatment arms.

Results

Mean age, American Society of Anesthesiologists (ASA) score and tumor type (predominantly metastatic colorectal cancer) were similar in both groups. Patients in the LRFA group had more tumors (2.1 ± 1.8 vs. 1.2 ± 0.6, p < 0.01), whereas tumors were larger in the LLR group (3.8 ± 1.6 vs. 2.8 ± 1.1 cm, p < 0.01). Although the operative time (116 vs. 214 min, p < 0.01) and hospital stay (2.1 vs. 3.4 days, p = 0.010) were shorter for the LRFA versus LLR group, respectively, morbidity (4.8 vs. 7.3 %) and mortality (0 vs. 0 %) were similar. Local recurrence was significantly higher in the LRFA versus LLR group (29 vs. 2.4 %, respectively, p = 0.002). However, there was no statistical difference in disease-free and overall survival between two groups (28 vs. 30 and 51 vs. 54 months, p = 0.443 and 0.768, respectively).

Conclusions

This study showed that LLR was tolerated as well as LRFA in elderly patients with similar comorbidities. We suggest LLR to be considered as an option in selected elderly patients who are deemed poor candidates for open hepatectomy.

Menon KV, Al-Mukhtar A, Aldouri A et al (2006) Outcomes after major hepatectomy in elderly patients. J Am Coll Surg 203:677–683CrossRefPubMed

Fong Y, Brennan MF, Cohen AM et al (1997) Liver resection in the elderly. Br J Surg. 84:1386–1390CrossRefPubMed

de Liguori Carino N, van Leeuwen BL, Ghaneh P et al (2008) Liver resection for colorectal liver metastases in older patients. Crit Rev Oncol Hematol 67:273–278CrossRef

Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825 Discussion 825-7 CrossRefPubMedPubMedCentral

Pawlik TM, Izzo F, Cohen DS et al (2003) Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 10:1059–1069CrossRefPubMed

Siperstein AE, Berber E, Ballem N et al (2007) Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 246:559–565 Discussion 565-7 CrossRefPubMed

Aliyev S, Agcaoglu O, Aksoy E, Taskin HE, Vogt D, Fung J, Siperstein A, Berber E (2013) Efficacy of laparoscopic radiofrequency ablation for the treatment of patients with small solitary colorectal liver metastasis. Surgery 154:556–562CrossRefPubMed

Hur H, Ko YT, Min BS et al (2009) Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg 197:728–736CrossRefPubMed

Aloia TA, Vauthey JN, Loyer EM et al (2006) Solitary colorectal liver metastasis: Resection determines outcome. Arch Surg 141:460–466 Discussion 466-7 CrossRefPubMed

10.

Tranchart H, Dagher I (2014) Laparoscopic Liver resection: a review. J Visc Surg 151:107–115CrossRefPubMed

11.

Tsinberg M, Tellioglu G, Simpfendorfer CH, Walsh RM, Vogt D, Fung J et al (2009) Comparison of laparoscopic versus open liver tumor resection: a case-controlled study. Surg Endosc 23:847–853CrossRefPubMed

12.

Berber E, Tsinberg M, Tellioglu G, Simpfendorfer CH, Siperstein AE (2008) Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg 12:1967–1972CrossRefPubMed

13.

Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW (2000) The Brisbane 2000 terminology of liver anatomy and resections. Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2:333–339

14.

Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99

15.

Azagra JS, Goergen M, Gilbart E et al (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy: technical aspects. Surg Endosc 10:758–761CrossRefPubMed

16.

Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21:619–624CrossRefPubMed

17.

Tzanis D, Shivathirthan N, Laurent A et al (2013) European experience of laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci 20:120–124CrossRefPubMed

18.

Mirnezami R, Mirnezami AH, Chandrakumaran K (2011) Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB 13:295–308CrossRefPubMedPubMedCentral

19.

Cauchy F, Fuks D, Nomi T, Dokmak S, Scatton O, Schwarz L, Barbier L, Belghiti J, Soubrane O, Gayet B (2016) Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 222(2):174–184.e10CrossRefPubMed

20.

Wood TF, Rose DM, Chung M, Allegra DP, Foshag LJ et al (2000) Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 7:593–600CrossRefPubMed

21.

Wu YZ, Li B, Wang T, Wang SJ, Zhou YM (2011) Radiofrequency ablation versus hepatic resection for solitary colorectal liver metastasis: a meta-analysis. World J Gastroenterol 17(36):4143–4148CrossRefPubMedPubMedCentral

22.

Karagkounis G, Seicean A, Berber E (2015) The impact of laparoscopic approaches on short-term outcomes in patients undergoing liver surgery for metastatic tumors. Surg Lap, Endosc Percutan Tech 25:229–234

23.

Schiergens TS, Stielow C, Schreiber S, Hornuss C, Jauch KW, Rentsch M, Thasler WE (2014) Liver resection in the elderly: significance of comorbidities and blood loss. J Gastrointest Surg 18:1161–1170. doi:10.1007/s11605-014-2516-2 Epub 2014 Apr 9 CrossRefPubMed

24.

Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243:373–379CrossRefPubMedPubMedCentral

25.

Faber W, Stockmann M, Schirmer C, Möllerarnd A, Denecke T, Bahra M, Klein F, Schott E, Neuhaus P, Seehofer D (2014) Significant impact of patient age on outcome after liver resection for HCC in cirrhosis. Eur J Surg Oncol 40:208–213CrossRefPubMed

26.

Wang WL, Zhu Y, Cheng JW, Li MX, Xia JM, Hao J, Yu L, Lv Y, Wu Z, Wang B (2014) Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis. Eur J Gastroenterol Hepatol 26:444–451CrossRefPubMed

27.

Kulik Framke T, Grosshennig A, Ceylan A, Bektas H, Klempnauer J, Lehner F (2011) Liver resection of colorectal liver metastases in elderly patients. World J Surg 35:2063–2072CrossRefPubMed

28.

Petrowsky H, Clavien PA (2005) Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients? World J Surg 29:1093–1100CrossRefPubMed

29.

Fong Y, Blumgart LH, Fortner JG et al (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222:426–434 Discussion 434–427 CrossRefPubMedPubMedCentral

30.

Aldrighetti L, Arru M, Caterini R et al (2003) Impact of advanced age on the outcome of liver resection. World J Surg 27:1149–1154CrossRefPubMed

31.

Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC (2011) Safety of liver resection in the elderly: How important is age? Ann Surg Oncol 18:1088–1095CrossRefPubMed

32.

Wang XT, Wang HG, Duan WD, Wu CY, Chen MY, Li H, Huang X, Zhang FB, Dong JH (2015) Pure laparoscopic versus open liver resection for primary liver carcinoma in elderly patients: a single-center, case-matched study. Medicine (Baltimore). 94:e1854CrossRefPubMedPubMedCentral

33.

Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection 2804 patients. Ann Surg 250:831–841CrossRefPubMed

34.

Sarpel U, Hefti MM, Wisnievsky JP et al (2009) Outcome for patients treated with laparoscopic versus open resection of hepato-cellular carcinoma: case-matched analysis. Ann Surg Oncol 16:1572–1577CrossRefPubMed

35.

Aldrighetti L, Guzzetti E, Pulitano C et al (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefPubMed

36.

Akyuz M, Yazici P, Yigitbas H, Dural C, Okoh A, Aliyev S, Aucejo F, Quintini C, Fung J, Berber E (2016) Oncologic results of laparoscopic liver resection for malignant liver tumors. J Surg Oncol 113:127–129CrossRefPubMed

Title: A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation
Authors: Pinar Yazici
Muhammet Akyuz
Hakan Yigitbas
Cem Dural
Alexis Okoh
Nail Aydin
Eren Berber
Publication date: 01-03-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5105-5

At a glance: The STEP trials

Springer Medicine

A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2017

Prone position in thoracoscopic esophagectomy improves postoperative oxygenation and reduces pulmonary complications

How many samples would be optimal for endobronchial cryobiopsy?

Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial

Erratum to: Esophageal stent fixation with endoscopic suturing device improves clinical outcomes and reduces complications in patients with locally advanced esophageal cancer prior to neoadjuvant therapy: a large multicenter experience

Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes

Short-term strength of non-penetrating mesh fixation: LifeMesh™, Tisseel™, and ProGrip™