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<p>The outcomes of laparoscopic liver resection (LLR) for large (≥ 5&#xa0;cm) hepatocellular carcinoma (HCC) in elderly (≥ 70&#xa0;years old) patients have not been deeply investigated so far. The aim of the study was to compare short- and long-term results of LLR vs. open liver resection (OLR) in this setting. Data regarding all patients undergoing liver resection for large HCC were retrospectively collected from referral European and Asian HPB centers. The cases were propensity score matched for age, BMI, center, underlying liver cirrhosis, comorbidities, extent of the resection, tumor size, and numbers. After matching 363 patients with large HCC aged ≥ 70&#xa0;years old, two cohorts of 90 patients were compared. The laparoscopic group showed a shorter median length of hospital stay (7 vs 9&#xa0;days, <i>p</i> = 0.01), with a lower rate of R1 resections (4.4% vs 13.3%, <i>p</i> = 0.03). No statistically significant differences were found in the median operative time (<i>p</i> = 0.34), intraoperative blood transfusions (<i>p</i> = 1.00), severe postoperative complications (<i>p</i> = 0.29), postoperative hemorrhage (<i>p</i> = 0.30), post-hepatectomy liver failure (<i>p</i> = 0.47), or in-hospital mortality (<i>p</i> = 0.31). After a median follow-up of 35&#xa0;months (95% CI 27.6–42.3), there were no statistically significant differences in both overall survival (<i>p</i> = 0.28) and disease-free survival (<i>p</i> = 0.42). LLR was safe and effective in selected cases of large HCC in elderly patients and was proven to shorten median hospital stay and to reduce the R1 rates, without affecting both short- and long-term survival outcomes.</p>

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Laparoscopic versus open liver resection for large (≥ 5 cm) hepatocellular carcinoma in elderly patients: a multicenter propensity score-matched study

  • 期刊论文

  • 发表日期：

    2025年4月2日

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  • Gianluca Cassese,
  • Fabio Giannone,
  • Federica Cipriani,
  • Antonio Cubisino,
  • Rami Rhaiem,
  • Bruno Branciforte,
  • Edoardo Maria Muttillo,
  • Bader Al Taweel,
  • Alessandro Tropea,
  • Emanuele Felli,
  • Raffaele Brustia,
  • Daniele Sommacale,
  • Ephrem Salame,
  • Patrick Pessaux,
  • Salvatore Gruttadauria,
  • Gian Luca Grazi,
  • Guido Torzilli,
  • Tullio Piardi,
  • Ho-Seong Han,
  • Mickael Lesurtel,
  • Luca Aldrighetti,
  • Fabrizio Panaro

摘要

The outcomes of laparoscopic liver resection (LLR) for large (≥ 5 cm) hepatocellular carcinoma (HCC) in elderly (≥ 70 years old) patients have not been deeply investigated so far. The aim of the study was to compare short- and long-term results of LLR vs. open liver resection (OLR) in this setting. Data regarding all patients undergoing liver resection for large HCC were retrospectively collected from referral European and Asian HPB centers. The cases were propensity score matched for age, BMI, center, underlying liver cirrhosis, comorbidities, extent of the resection, tumor size, and numbers. After matching 363 patients with large HCC aged ≥ 70 years old, two cohorts of 90 patients were compared. The laparoscopic group showed a shorter median length of hospital stay (7 vs 9 days, p = 0.01), with a lower rate of R1 resections (4.4% vs 13.3%, p = 0.03). No statistically significant differences were found in the median operative time (p = 0.34), intraoperative blood transfusions (p = 1.00), severe postoperative complications (p = 0.29), postoperative hemorrhage (p = 0.30), post-hepatectomy liver failure (p = 0.47), or in-hospital mortality (p = 0.31). After a median follow-up of 35 months (95% CI 27.6–42.3), there were no statistically significant differences in both overall survival (p = 0.28) and disease-free survival (p = 0.42). LLR was safe and effective in selected cases of large HCC in elderly patients and was proven to shorten median hospital stay and to reduce the R1 rates, without affecting both short- and long-term survival outcomes.