Defining the Role of Laparoscopic Liver Resection in Elderly Hepatocellular Carcinoma Patients: A Propensity Score Matched Analysis

Objective: To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma(HCC). Method: A retrospective comparative analysis between laparoscopic and open liver resection was performed. Consecutive HCC patients aged 65 or above at the time of operation were recruited. Patients with recurrent HCC and pathology other than HCC were excluded. Short term and long-term outcomes of laparoscopic liver resection were compared with that of open group. Propensity score matching of patients in a ratio of 1:2 were conducted before comparison. Results: There were 911 patients who underwent hepatectomy for primary HCC from year 2008 to 2018. Among them, 320 elderly patients aged over 65 years old were eligible for analysis. Heterogeneities between laparoscopic and open group were identified namely pre-operative albumin level, aspartate transaminase and proportion of hepatectomy (major vs minor). After propensity score matching of 1:2, there were 46 patients and 92 patients in the laparoscopic group and the open group respectively for comparison. The laparoscopic group had less blood loss (326 vs 735 ml; P< 0.001), shorter operative time (223 vs 324 minutes; P< 0.001), and shorter hospital stay (6.3 vs 10.5 days; P< 0.001). There were no significant differences in post-operative morbidity and hospital mortality. Laparoscopic group had a superior disease-free survival (59.7% vs 44.5%, P=0.041), and a trend towards better overall survival. (78.4% vs 64.8% P=0.110). Conclusion: Laparoscopic liver resection is a safe approach for elderly patients with HCC with benefits from faster recovery and better oncological outcomes.