Department of Biliary Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China.
Department of Liver Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan Province, PR China.
Eur J Surg Oncol. 2021 Oct;47(10):2675-2681. doi: 10.1016/j.ejso.2021.04.032. Epub 2021 Apr 30.
Resection is still the most efficacious treatment to hepatocellular carcinoma (HCC), among which laparoscopic liver resection (LLR) have controversial effects against conventional open procedure (OLR). With a predictable aging tendency of population worldwide, conventional surgical procedures need to be modified to better accommodate elderly patients. Here, we designed a retrospective study based on propensity score analysis, aiming to compare the efficacy of OLR and LLR in patients over 65 years.
We retrospectively analyzed patients with an age over 65 who underwent liver resection between January 2015 and September 2018. Patients were divided into the LLR group and OLR group. Short-term and long-term outcomes were compared before and after 1:1 propensity score matching.
Among 240 enrolled patients, 142 were matched with comparable baseline (71 each group). In the matched cohort, LLR group presented with shorter postoperative hospital stay (median 7 vs 6 days, p = 0.003) and fewer respiratory complications (19.7% vs. 7.0%, p = 0.049), especially pleural effusion (15.5% vs. 2.8%, p = 0.020). Meanwhile, LLR had comparable overall hospital cost (6142 vs. 6243 USD, p = 0.977) compared with OLR. The overall survival (OS) and disease-free survival (DFS) did not differ in the two groups.
Our study showed that laparoscopic liver resection for HCC in the older age groups is associated with shorter postoperative hospital stay and comparable hospital cost compared with open procedure, which could be attributable to less respiratory complications. We recommend that laparoscopy be taken as a priority option for elderly patients with resectable HCC.
肝切除术仍然是治疗肝细胞癌（HCC）最有效的方法，其中腹腔镜肝切除术（LLR）与传统开腹手术（OLR）的效果存在争议。随着全球人口老龄化的可预测趋势，传统的手术程序需要进行修改，以更好地适应老年患者。在这里，我们设计了一项回顾性研究，基于倾向评分分析，旨在比较 65 岁以上患者行 OLR 和 LLR 的疗效。
我们回顾性分析了 2015 年 1 月至 2018 年 9 月期间年龄超过 65 岁行肝切除术的患者。患者分为 LLR 组和 OLR 组。在进行 1:1 倾向评分匹配前后，比较了短期和长期结果。
在纳入的 240 例患者中，有 142 例患者与基线情况具有可比性（每组 71 例）。在匹配队列中，LLR 组术后住院时间更短（中位数 7 天比 6 天，p=0.003），呼吸并发症更少（19.7%比 7.0%，p=0.049），尤其是胸腔积液（15.5%比 2.8%，p=0.020）。同时，LLR 的总住院费用与 OLR 相当（6142 美元比 6243 美元，p=0.977）。两组的总生存（OS）和无病生存（DFS）无差异。
我们的研究表明，对于老年 HCC 患者，腹腔镜肝切除术与开腹手术相比，术后住院时间更短，住院费用相当，但呼吸并发症更少。我们建议将腹腔镜作为可切除 HCC 老年患者的首选方案。
