Surgical endoscopy · 2025
A multicenter case-controlled study on laparoscopic hepatectomy versus open liver resection as first-line therapy for solitary hepatocellular carcinoma in elderly patients.
СтатьяМногоцентровое исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Yang Shiye, Zhou Shuiping, Feng Jinkai, Zou Min, Zhang Jixiang, Zhang Aixian, Xia Chenyun, Gong Lin, He Xiao, Ming Zhibing
Аннотация
PURPOSE: This study aimed to compare perioperative and long-term outcomes between laparoscopic (LLR) and open liver resection (OLR) in elderly patients with solitary hepatocellular carcinoma (HCC).
METHODS: The study consecutively included patients aged ≥ 70 years who underwent curative liver resection for single HCC at four tertiary centers between January 2015 and December 2021. Perioperative short-term and long-term survival outcomes were compared between the LLR and OLR groups. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS).
RESULTS: Of the 180 patients, 94 and 86 were included in the LLR and OLR groups, respectively. After PSM, 65 patients were included in each group. Intraoperative blood loss (p = 0.010), operative time (p = 0.021), length of hospital stay (p = 0.021) and 90-day readmission rate (p = 0.048) were significantly lower in the matched LLR than the matched OLR group. Moreover, postoperative ascites complication was less frequent in the matched LLR group (p = 0.046). Long-term survival outcomes were better in the LLR group compared with the OLR group both before and after PSM (for OS: p = 0.019 and 0.003; for RFS: p = 0.023 and 0.012). Multivariate Cox regression analysis found that open hepatectomy was an independent risk factor of OS and RFS for elderly HCC patients compared to laparoscopic approach.
CONCLUSION: For selected elderly patients with solitary HCC, particularly those with tumors in locations amenable to a minimally invasive approach, LLR was associated with superior perioperative and long-term survival outcomes compared to OLR.
CLINICAL TRIALS REGISTRATION: Not applicable because this is a retrospective observational study.
METHODS: The study consecutively included patients aged ≥ 70 years who underwent curative liver resection for single HCC at four tertiary centers between January 2015 and December 2021. Perioperative short-term and long-term survival outcomes were compared between the LLR and OLR groups. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS).
RESULTS: Of the 180 patients, 94 and 86 were included in the LLR and OLR groups, respectively. After PSM, 65 patients were included in each group. Intraoperative blood loss (p = 0.010), operative time (p = 0.021), length of hospital stay (p = 0.021) and 90-day readmission rate (p = 0.048) were significantly lower in the matched LLR than the matched OLR group. Moreover, postoperative ascites complication was less frequent in the matched LLR group (p = 0.046). Long-term survival outcomes were better in the LLR group compared with the OLR group both before and after PSM (for OS: p = 0.019 and 0.003; for RFS: p = 0.023 and 0.012). Multivariate Cox regression analysis found that open hepatectomy was an independent risk factor of OS and RFS for elderly HCC patients compared to laparoscopic approach.
CONCLUSION: For selected elderly patients with solitary HCC, particularly those with tumors in locations amenable to a minimally invasive approach, LLR was associated with superior perioperative and long-term survival outcomes compared to OLR.
CLINICAL TRIALS REGISTRATION: Not applicable because this is a retrospective observational study.