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01-12-2018 | Original Scientific Report

Perioperative Outcomes of Laparoscopic Minor Hepatectomy for Hepatocellular Carcinoma in the Elderly

Authors: Brian K. P. Goh, Darren Chua, Nicholas Syn, Jin-Yao Teo, Chung-Yip Chan, Ser-Yee Lee, Prema Raj Jeyaraj, Peng-Chung Cheow, Pierce K. H. Chow, London L. P. J. Ooi, Alexander Y. F. Chung

Published in: World Journal of Surgery | Issue 12/2018

Abstract

Introduction

This study aims to evaluate the safety and feasibility of laparoscopic minor hepatectomy (LMH) in elderly patients with hepatocellular carcinoma (HCC).

Methods

A total of 40 consecutive elderly (≥ 70 years) patients were compared with 94 young patients (< 70 years). The 40 patients were also compared with 85 consecutive elderly patients who underwent open minor hepatectomies (OMH). After 1:1 propensity-score matching (PSM), 32 LMHs were compared with 32 OMHs in elderly patients.

Results

Comparison between the baseline characteristics of elderly and young HCC patients showed that elderly patients were significantly more likely to have comorbidities, ASA score > 2, non-hepatitis B, previous liver resection and larger tumor size. Comparison between perioperative outcomes demonstrated that elderly patients were significantly more likely to have a longer operation time, increased blood loss, increased need for blood transfusion, longer Pringles duration and longer postoperative stay. Comparison between LMH and OMH in elderly patients demonstrated no significant difference in baseline characteristics except the LMH cohort were significantly more likely to have > 1 comorbidity, higher platelet count and lower median AFP level. Comparison between outcomes before and after PSM demonstrated that LMH was associated with longer operation time, increased blood loss, longer Pringles duration but decreased postoperative pulmonary complications and shorter postoperative stay compared to OMH.

Conclusion

LMH is safe and feasible in elderly patients with HCC. However, LMH in elderly patients is associated with poorer perioperative outcomes compared to LMH in young patients. Comparison between LMH and OMH in elderly patients demonstrated advantages in terms of decreased pulmonary complications and shorter length of stay at the expense of increased operation time and blood loss.

Chan AC, Poon RT, Cheung TT et al (2014) Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: a single-center experience. J Gastro Hepatol 29:1279–1283CrossRef

Nomi T, Fuks D, Kawaguchi Y (2015) Laparoscopic major hepatectomy for colorectal liver metastases in elderly patients: a single-center, case-matched study. Surg Endosc 29:1368–1375CrossRef

World Health Statistics (2016) Monitoring health for the SDGs Annex B: tables of health statistics by country, WHO region and globally. World Health Organization, Geneva, p 2016

Cucchetti A, Sposito C, Pinna AD et al (2016) Effect of age on survival in patients undergoing resection of hepatocellular carcinoma. Br J Surg 103:e93–e99CrossRef

Faber W, Stockmann M, Schirmer C et al (2014) Significant impact of patient age on outcome after liver resection for HCC in cirrhosis. EJSO 40:208–213CrossRef

Wang WL, Zhu Y, Cheng J et al (2014) Major hepatectomy is safe for hepatocellular carcinoma in elderly patients with cirrhosis. Eur J Gas Hepatol 26:444–451CrossRef

Bauschke A, Altendorf-Hofmann A, Mothes H et al (2016) Partial liver resection results in a significantly better long-term survival than locally ablative procedures even in elderly patients. J Cancer Res Clin Oncol 142:1099–1108CrossRef

Ciria R, Cherqui D, Geller DA et al (2016) Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777CrossRef

Sposito C, Battiston C, Facciorusso A et al (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880CrossRef

10.

Takahara T, Wakabayashi G, Beppu T et al (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727CrossRef

11.

Han HS, Shehta A, Ahn S et al (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650CrossRef

12.

Badawy A, Seo S, Toda R et al (2017) A propensity score-based analysis of laparoscopic liver resection for liver malignancies in elderly patients. J Invest Surg 17:1–8CrossRef

13.

Martinez-Cecilia D, Cipriani F, Vishal S et al (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265:1192–1200CrossRef

14.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and result of a survey. Ann Surg 240(2):205–213CrossRef

15.

Goh BK, Chan CY, Wong JS et al (2015) Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy. Surg Endosc 29:2636–2642CrossRef

16.

Goh BK, Teo JY, Chan CY et al (2017) Evolution of laparoscopic liver resection at Singapore General Hospital: a nine-year experience of 195 consecutive resections. Singap Med J 58:708–713CrossRef

17.

Goh BK, Teo JY, Lee SY et al (2018) Critical appraisal of the impact of individual surgeon experience on the outcomes of laparoscopic liver resection in the modern era: collective experience of multiple surgeons at a single institution with 324 consecutive cases. Surg Endosc 32(4):1802–1811CrossRef

18.

Strasberg SM (2005) Nomenclature of Hepatic anatomy and resection: a review of Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12(5):351–355CrossRef

19.

Uchida H, Iwashita Y, Watanabe K, Takayama H et al (2015) Surgical outcomes of laparoscopic liver resection in elderly patients: a comparative study from a single center. Surg Laparosc Endosc Percutan Tech 25:e109–e112CrossRef

20.

Cauchy F, Fuks D, Nomi T et al (2016) Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 222:174–184CrossRef

21.

Wang XT, Wang HG, Duan WD et al (2015) Pure laparoscopic versus open liver resection for primary liver carcinoma in elderly patients. Medicine 94:e1854CrossRef

22.

Spampinato MG, Arvanitakis M, Puleo F et al (2013) Totally laparoscopic liver resections for primary and metastatic cancer in elderly: safety, feasibility and short-term outcomes. Surg Endosc 27:1881–1886CrossRef

Title: Perioperative Outcomes of Laparoscopic Minor Hepatectomy for Hepatocellular Carcinoma in the Elderly
Authors: Brian K. P. Goh
Darren Chua
Nicholas Syn
Jin-Yao Teo
Chung-Yip Chan
Ser-Yee Lee
Prema Raj Jeyaraj
Peng-Chung Cheow
Pierce K. H. Chow
London L. P. J. Ooi
Alexander Y. F. Chung
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 12/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4741-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Perioperative Outcomes of Laparoscopic Minor Hepatectomy for Hepatocellular Carcinoma in the Elderly

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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