Elderly Hepatocellular Carcinoma Patients: Open or Laparoscopic Approach?

Jong Man Kim,Choon Hyuck David Kwon,Gyu-Seong Choi,Jinsoo Rhu,Jae-Won Joh,Sangjin Kim

doi:10.3390/cancers12082281

Jong Man Kim, Choon Hyuck David Kwon + Show 4 more

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https://doi.org/10.3390/cancers12082281

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Abstract

It remains unclear whether the short-term benefits and long-term outcomes of laparoscopic liver resection (LLR) accrue to elderly patients with medical comorbidities. The aim of the present study was to compare the outcomes between LLR and open liver resection (OLR) in elderly patients (≥65 years) with solitary, treatment-naïve solitary hepatocellular carcinoma (HCC). From January 2013 to August 2017, 256 elderly patients with solitary treatment-naive HCC underwent liver resection. All patients were Child–Pugh class A and older than 65 years. The OLR and LLR groups contained 160 and 96 patients, respectively. The median tumor size in the OLR group was significantly larger than that in the LLR group (3.9 vs. 2.6 cm), but the tumor size did not differ between the two groups after matching. The median operation time, blood loss, transfusion rate, and postoperative complications in the OLR group did not differ from those in the LLR group, but the operation time in the LLR group was longer than that in the OLR group after matching. The median hospitalization in the LLR group was significantly shorter than that in the OLR group. Disease-free survival (DFS) in the LLR group was better than that in the OLR group before and after matching, but the difference was not significant. Patient survival (PS) in the LLR group was similar to that in the OLR group. LLR is feasible and safe for elderly patients with solitary, treatment-naïve HCC. The short- and long-term benefits of LLR are evident in geriatric oncological liver surgery patients.

Highlights

As life expectancy continues to increase, the number of elderly individuals is constantly growing worldwide [1]
Old age is widely considered to be a risk factor for hepatocellular carcinoma (HCC) [2], and a 67% increase in cancer incidence among patients older than 65 years from 2010 to 2030 has been predicted, whereas only an 11% increase is expected among younger people; among those cancers, more than 88% of hepatobiliary malignancies are expected to occur among patients more than 65 years old [3]
We found that the open liver resection (OLR) and laparoscopic liver resection (LLR) groups had similar Disease-free survival (DFS) and Patient survival (PS) rates before and after matching

Summary

Introduction

As life expectancy continues to increase, the number of elderly individuals is constantly growing worldwide [1]. As the general population continues to age, the need for the surgical management of elderly patients increases. Patients frequently present with more comorbidities than young patients, especially cardiovascular and pulmonary diseases, which increases their risk of postoperative complications [4,5]. Many surgeons are reluctant to operate due to the risk of aging, the risk of bleeding during hepatectomy, and the possibility of liver failure after hepatectomy in elderly HCC patients with cirrhosis [6].

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