Benefits of Laparoscopic Liver Resection in Elderly Patients

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2023 Mar 22

PMID 36947226

Authors

Shozo Mori

Taiga Wakabayashi

Kohei Mishima

Takahiro Ozaki

Yoshiki Fujiyama

Go Wakabayashi

Affiliations

Soon will be listed here.

Abstract

Background: The indications of laparoscopic liver resection (LLR) have expanded to high-risk patients, such as elderly people. However, to date, little evidence has been established of the safety and feasibility of LLR in elderly patients. The short-term outcomes of LLR in elderly patients as compared to non-elderly patients were investigated.

Methods: Data of a total of 297 patients who underwent LLR were reviewed. Among these 297 patients, 181 patients were < 75 years age (non-elderly) and 116 patients were ≥ 75 years age (elderly), and the surgical outcomes were compared between the groups. In addition, we evaluated the risk factors for postoperative morbidity (Clavien-Dindo grade ≥ IIIa) utilizing the preoperative, operative, and postoperative variables RESULTS: The preoperative liver/renal function, frequency of anti-thrombotic drug use, number of comorbidities, and American Society of Anesthesiologists-physical status classification were more unfavorable in elderly patients than in non-elderly patients. No significant inter-group differences were observed in the operation time, blood loss, conversion rate, postoperative morbidity, or 30-day mortality. The 3-year overall survival rate was comparable between the two groups. Multivariate analysis identified anti-thrombotic drug use, operation time > 7 h, and peak serum total bilirubin > 2 mg/dl within postoperative day 3 as independent risk factors for Clavien-Dindo ≥ IIIa postoperative morbidity (P = 0.016, P < 0.001, and P = 0.001, respectively).

Conclusions: LLR in elderly patients may provide comparable short-term outcomes to those in non-elderly patients.

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References

Petrowsky H, Clavien P . Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients?. World J Surg. 2005; 29(9):1093-100. DOI: 10.1007/s00268-005-1130-6. View

Anaya D, Becker N, Abraham N . Global graying, colorectal cancer and liver metastasis: new implications for surgical management. Crit Rev Oncol Hematol. 2010; 77(2):100-8. DOI: 10.1016/j.critrevonc.2010.02.003. View

Kudo M, Izumi N, Kubo S, Kokudo N, Sakamoto M, Shiina S . Report of the 20th Nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res. 2019; 50(1):15-46. PMC: 7003938. DOI: 10.1111/hepr.13438. View

Booth C, Nanji S, Wei X, Mackillop W . Management and Outcome of Colorectal Cancer Liver Metastases in Elderly Patients: A Population-Based Study. JAMA Oncol. 2015; 1(8):1111-9. DOI: 10.1001/jamaoncol.2015.2943. View

Fretland A, Dagenborg V, Bjornelv G, Kazaryan A, Kristiansen R, Fagerland M . Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Ann Surg. 2017; 267(2):199-207. DOI: 10.1097/SLA.0000000000002353. View

Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N . 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. 2015; 22(10):721-7. DOI: 10.1002/jhbp.276. View

Cheung T, Dai W, Tsang S, Chan A, Chok K, Chan S . Pure Laparoscopic Hepatectomy Versus Open Hepatectomy for Hepatocellular Carcinoma in 110 Patients With Liver Cirrhosis: A Propensity Analysis at a Single Center. Ann Surg. 2016; 264(4):612-20. DOI: 10.1097/SLA.0000000000001848. View

Ban D, Tanabe M, Kumamaru H, Nitta H, Otsuka Y, Miyata H . Safe Dissemination of Laparoscopic Liver Resection in 27,146 Cases Between 2011 and 2017 From the National Clinical Database of Japan. Ann Surg. 2020; 274(6):1043-1050. DOI: 10.1097/SLA.0000000000003799. View

Hwang D, Han H, Yoon Y, Cho J, Kwon Y, Kim J . Laparoscopic major liver resection in Korea: a multicenter study. J Hepatobiliary Pancreat Sci. 2012; 20(2):125-30. DOI: 10.1007/s00534-012-0555-1. View

10.

Wakabayashi T, Benedetti Cacciaguerra A, Ciria R, Ariizumi S, Duran M, Golse N . Landmarks to identify segmental borders of the liver: A review prepared for PAM-HBP expert consensus meeting 2021. J Hepatobiliary Pancreat Sci. 2021; 29(1):82-98. DOI: 10.1002/jhbp.899. View

11.

Martinez-Cecilia D, Cipriani F, Shelat V, Ratti F, Tranchart H, Barkhatov L . 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. 2017; 265(6):1192-1200. DOI: 10.1097/SLA.0000000000002147. View

12.

Wang X, Wang H, Duan W, Wu C, Chen M, Li H . Pure Laparoscopic Versus Open Liver Resection for Primary Liver Carcinoma in Elderly Patients: A Single-Center, Case-Matched Study. Medicine (Baltimore). 2015; 94(43):e1854. PMC: 4985409. DOI: 10.1097/MD.0000000000001854. View

13.

Badawy A, Seo S, Toda R, Fuji H, Fukumitsu K, Ishii T . A Propensity Score-Based Analysis of Laparoscopic Liver Resection for Liver Malignancies in Elderly Patients. J Invest Surg. 2017; 32(1):75-82. DOI: 10.1080/08941939.2017.1373170. View

14.

Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B . Laparoscopic major hepatectomy for colorectal liver metastases in elderly patients: a single-center, case-matched study. Surg Endosc. 2014; 29(6):1368-75. DOI: 10.1007/s00464-014-3806-1. View

15.

Spampinato M, Arvanitakis M, Puleo F, Mandala L, Quarta G, Traisci D . Totally laparoscopic liver resections for primary and metastatic cancer in the elderly: safety, feasibility and short-term outcomes. Surg Endosc. 2012; 27(6):1881-6. DOI: 10.1007/s00464-012-2687-4. View

16.

Uchida H, Iwashita Y, Watanabe K, Takayama H, Kawasaki T, Yada K . Surgical Outcomes of Laparoscopic Liver Resection in Elderly Patients: A Comparative Study From a Single Center. Surg Laparosc Endosc Percutan Tech. 2015; 25(4):e109-12. DOI: 10.1097/SLE.0000000000000183. View

17.

Cauchy F, Fuks D, Nomi T, Dokmak S, Scatton O, Schwarz L . Benefits of Laparoscopy in Elderly Patients Requiring Major Liver Resection. J Am Coll Surg. 2015; 222(2):174-84.e10. DOI: 10.1016/j.jamcollsurg.2015.11.006. View

18.

Berardi G, Igarashi K, Li C, Ozaki T, Mishima K, Nakajima K . Parenchymal Sparing Anatomical Liver Resections With Full Laparoscopic Approach: Description of Technique and Short-term Results. Ann Surg. 2019; 273(4):785-791. DOI: 10.1097/SLA.0000000000003575. View

19.

Funamizu N, Ozaki T, Mishima K, Igarashi K, Omura K, Takada Y . Evaluation of accuracy of laparoscopic liver mono-segmentectomy using the Glissonian approach with indocyanine green fluorescence negative staining by comparing estimated and actual resection volumes: A single-center retrospective cohort study. J Hepatobiliary Pancreat Sci. 2021; 28(12):1060-1068. DOI: 10.1002/jhbp.924. View

20.

Wakabayashi G, Cherqui D, Geller D, Abu Hilal M, Berardi G, Ciria R . The Tokyo 2020 terminology of liver anatomy and resections: Updates of the Brisbane 2000 system. J Hepatobiliary Pancreat Sci. 2021; 29(1):6-15. DOI: 10.1002/jhbp.1091. View