Laparoscopic vs open liver resection for hepatocellular carcinoma in elderly cirrhotic patients: a propensity score matching analysis

Introduction: Laparoscopic liver resection has been associated with less morbidity and similar oncological results compared to open surgery. The aim of this paper was to evaluate if this benefit continues to be observed in elderly patients. Method: In order to evaluate postoperative and long-term outcome of laparoscopic liver resection (LLR) and open liver resection (OLR), 690 elderly (>70 years) cirrhotic patients with hepatocellular carcinoma were analysed from a multicentric retrospective database. Patients were matched in a 1:1 propensity score matching analysis (PSM) in order to compare equivalent group on age, sex, BMI, comorbidities, MELD score, number of lesion, size of lesions. Results: After propensity score matching (PSM), 199 patients with LLR were compared to 199 patients with OLR. The 2 groups were comparable concerning the rate of major hepatectomies (26% in OLR vs 19% in LLR, p = 0.12). Procedure related blood transfusion were more frequent in OLR (22% vs 12%, p = 0.005), with a higher rate of postoperative complication (47% vs 29%, p = 0.002), with more Dindo Clavien grade III-IV complications in OLR (12% vs 6%, p = 0.05), with 3 postoperative death in OLR (1.5% vs 0%, p = 0.12). Longer hospitalisation was evidenced in OLR (10.9 ± 1.4 days vs 6.7 ± 0.3, p = 0.002). 1, 3, 5-year overall survival were inferior in OLR compared LLR group (89%, 77%, 67% vs 95%, 87%, 73%, p = 0.01), with similar disease free survival among OLR and LLR (85%, 62%, 54% vs 83%, 65%, 55%, p = 0.57). Conclusion: LLR is feasible and safe in elderly cirrhotic patients, with a better postoperative course and better overall survival compared to OLR.