Department of Surgery, Kokura Memorial Hospital, Fukuoka, Japan.
Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan.
Asian J Endosc Surg. 2022 Apr;15(2):279-289. doi: 10.1111/ases.12994. Epub 2021 Oct 5.
BACKGROUND/PURPOSE: The safety of laparoscopic liver resection in super-elderly patients with comorbidities is unknown. We used propensity score matching to evaluate the utility and safety of laparoscopic liver resection in super-elderly patients.
Two-hundred and five patients who underwent laparoscopic liver resection were retrospectively reviewed. They were classified into two groups based on age: ≥80 years (elderly group, n = 49) and <80 years (control group, n = 156). Propensity score matching (PSM) was performed based on preoperative clinical parameters. The intraoperative and postoperative outcomes were compared.
After matching, 45 patients were included in each group. The intraoperative blood loss was identical between the control and elderly groups (60 vs 60 mL, respectively, P = .588); the frequency of serious postoperative complications (Clavien-Dindo class ≥3, 1/45 vs 1/45, P = 1.00) was also similar. There was no significant difference in terms of the exacerbation of malignancy (22.2% vs 11.1%, P = .258) or other diseases (8.9% vs 22.2%, P = .144). There was no difference in overall survival before and after PSM. However, 5-year overall survival excluding primary cancer-related death showed a difference after PSM (90.7% vs 70.4%; P = .048).
Laparoscopic liver resection is feasible and safe in super-elderly patients. The long-term prognosis was poor in patients affected by other illnesses compared to the younger population with similar risk profiles, but there was no difference in overall survival.
背景/目的：腹腔镜肝切除术在合并症的超高龄患者中的安全性尚不清楚。我们使用倾向评分匹配来评估腹腔镜肝切除术在超高龄患者中的实用性和安全性。
回顾性分析了 205 例行腹腔镜肝切除术的患者。根据年龄将他们分为两组：≥80 岁（老年组，n=49）和<80 岁（对照组，n=156）。基于术前临床参数进行倾向评分匹配（PSM）。比较了术中及术后结果。
匹配后，每组各有 45 例患者。对照组和老年组的术中出血量相同（分别为 60 毫升和 60 毫升，P=0.588）；严重术后并发症（Clavien-Dindo 分级≥3）的发生率也相似（1/45 比 1/45，P=1.00）。恶性肿瘤恶化的比例（22.2%比 11.1%，P=0.258）或其他疾病的比例（8.9%比 22.2%，P=0.144）无显著差异。PSM 前后总生存率无差异。然而，PSM 后排除原发性癌症相关死亡的 5 年总生存率存在差异（90.7%比 70.4%；P=0.048）。
腹腔镜肝切除术在超高龄患者中是可行且安全的。与具有相似风险特征的年轻人群相比，患有其他疾病的患者长期预后较差，但总生存率无差异。
