Minimally invasive ver-sus open liver resection for hepatocellular carcinoma in the elderly: international multicentre propensity score-matched study
Jasper P Sijberden 1 2 3 , Federica Cipriani 4 , Jacopo Lanari 5 , Nadia Russolillo 6 , Andrea Benedetti Cacciaguerra 7 , Daniel Osei-Bordom 8 , Simone Conci 9 , Burak Görgec 2 3 , John N Primrose 10 , Bjørn Edwin 11 , Santi López-Ben 12 , Mathieu D'Hondt 13 , Fernando Rotellar 14 , Marc G Besselink 2 3 , Ibrahim Dagher 15 , Felice Giuliante 16 , David Fuks 17 , Renzo Rozzini 18 , Andrea Ruzzenente 9 , Robert P Sutcliffe 8 , Marco Vivarelli 7 , Alessandro Ferrero 6 , Umberto Cillo 5 , Luca A Aldrighetti 4 , Mohammad Abu Hilal 1 10
Hepatocellular carcinoma (HCC) is a disease with a high burden mainly affecting elderly patients. Most patients have underlying liver cirrhosis1,2. Elderly patients are increasingly seeking treatment for HCC in parallel with rising incidence and general life expectancy2–4. Resection is considered the most suitable curative option in elderly patients. Improvements in perioperative care and surgical techniques have mitigated the risks of resection, thereby expanding the pool of patients considered for resection1,5.
One such improvement has been the adoption of minimally invasive liver surgery (MILS)6. For HCC, MILS has been associated with a shorter hospital stay, less blood loss, fewer transfusions, as well as lower mortality, and overall and liver-specific morbidity rates7–10. Concerns have been expressed, however, regarding its safety in elderly patients. The specific physiological stress endured during minimally invasive surgery might increase the morbidity and mortality risk in patients with limited reserve, but this hypothesis has not yet been supported by strong evidence11,12.
Evidence for the safety of MILS for HCC in elderly patients remains limited and mostly originates from single-centre studies investigating outcomes after minor hepatectomies, seldom reporting long-term outcomes12. Moreover, elderly patients are often analysed as a single group, ignoring the risks associated with increasing age. This study, therefore, aimed to compare perioperative and long-term outcomes of MILS and open liver surgery (OLS) in a large cohort of elderly patients with HCC, and included a subgroup analysis of outcomes in octogenarians.
CITATION Br J Surg. 2022 Dec 13;znac423. doi: 10.1093/bjs/znac423