The efficacy and safety of totally laparoscopic hepatectomy for non-cirrhotic hepatocellular carcinoma in the elderly

Laparoscopic hepatectomy (LH) has been identified to be effective and safe for elderly patients (≥70 years). This study aims to assess the short-and long-term outcome of totally laparoscopic liver resection for elderly patients with Hepatocellular carcinoma (HCC).

We retrospectively reviewed 93 patients with HCC who underwent LH from August, 2003 to July, 2013 in a single center. Short-term operative and postoperative outcomes together with long-term outcomes, including disease free survival (DFS) and overall survival (OS) were analyzed.

A total of 81 patients was finally reviewed, of which 23 patients (28.40%) were grouped to elderly (≥70 years) and 58 patients (71.60%) were divided into younger group (< 70 years). The mean ages of patients in the elderly and younger cohorts were 74.9 ± 3.4 and 50.9 ± 12.7 years old, respectively. The median follow-up durations in elderly cohort and young cohort were 30 months and 24 months. The mean postoperative hospital stay was nearly 4 days longer in the elderly cohort than that in younger group (13.4 vs 9.5; p = 0.003). The elderly cohort has a higher rate of non-surgical complications than that in the younger cohort (P = 0.045), while the risks of surgical complications were comparable between the two groups. For the postoperative complications, elderly patients were more easily to develop grade III or more of Clavien-Dindo classification than that in the younger patients (P = 0.008). The median OS in the elderly group and younger group was 44.09 months and 42.49 months, respectively, with p = 0.089. The median DFS in the elderly group and the younger group was 39.87 months and 37.86 months, respectively, with p = 0.0616.

Elderly patients could obtain comparable operative and survival benefits from LH for HCC as younger counterparts. Age may not be a contraindication to laparoscopic liver resection for elderly patients.