Goh Brian K P, Chua Darren, Syn Nicholas, Teo Jin-Yao, Chan Chung-Yip, Lee Ser-Yee, Jeyaraj Prema Raj, Cheow Peng-Chung, Chow Pierce K H, Ooi London L P J, Chung Alexander Y F
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore.
Duke-National University of Singapore Medical School, Singapore, Singapore.
World J Surg. 2018 Dec;42(12):4063-4069. doi: 10.1007/s00268-018-4741-4.
This study aims to evaluate the safety and feasibility of laparoscopic minor hepatectomy (LMH) in elderly patients with hepatocellular carcinoma (HCC).
A total of 40 consecutive elderly (≥ 70 years) patients were compared with 94 young patients (< 70 years). The 40 patients were also compared with 85 consecutive elderly patients who underwent open minor hepatectomies (OMH). After 1:1 propensity-score matching (PSM), 32 LMHs were compared with 32 OMHs in elderly patients.
Comparison between the baseline characteristics of elderly and young HCC patients showed that elderly patients were significantly more likely to have comorbidities, ASA score > 2, non-hepatitis B, previous liver resection and larger tumor size. Comparison between perioperative outcomes demonstrated that elderly patients were significantly more likely to have a longer operation time, increased blood loss, increased need for blood transfusion, longer Pringles duration and longer postoperative stay. Comparison between LMH and OMH in elderly patients demonstrated no significant difference in baseline characteristics except the LMH cohort were significantly more likely to have > 1 comorbidity, higher platelet count and lower median AFP level. Comparison between outcomes before and after PSM demonstrated that LMH was associated with longer operation time, increased blood loss, longer Pringles duration but decreased postoperative pulmonary complications and shorter postoperative stay compared to OMH.
LMH is safe and feasible in elderly patients with HCC. However, LMH in elderly patients is associated with poorer perioperative outcomes compared to LMH in young patients. Comparison between LMH and OMH in elderly patients demonstrated advantages in terms of decreased pulmonary complications and shorter length of stay at the expense of increased operation time and blood loss.
本研究旨在评估腹腔镜下小肝癌切除术（LMH）在老年肝细胞癌（HCC）患者中的安全性和可行性。
将40例连续的老年（≥70岁）患者与94例年轻患者（<70岁）进行比较。这40例患者还与85例连续接受开放性小肝癌切除术（OMH）的老年患者进行比较。在1:1倾向评分匹配（PSM）后，将32例LMH与32例老年患者的OMH进行比较。
老年和年轻HCC患者基线特征的比较显示，老年患者合并症、美国麻醉医师协会（ASA）评分>2、非乙型肝炎、既往肝切除术和肿瘤体积较大的可能性显著更高。围手术期结果的比较表明，老年患者手术时间显著更长、失血量增加、输血需求增加、肝门阻断时间延长和术后住院时间延长的可能性显著更高。老年患者中LMH与OMH的比较显示，除LMH组合并症>1、血小板计数较高和甲胎蛋白（AFP）中位数水平较低的可能性显著更高外，基线特征无显著差异。PSM前后结果的比较表明，与OMH相比，LMH与手术时间延长、失血量增加、肝门阻断时间延长相关，但术后肺部并发症减少且术后住院时间缩短。
LMH在老年HCC患者中是安全可行的。然而，与年轻患者的LMH相比，老年患者的LMH围手术期结果较差。老年患者中LMH与OMH的比较显示，以手术时间和失血量增加为代价，在减少肺部并发症和缩短住院时间方面具有优势。
