title: Totally laparoscopic liver resections for primary and metastatic cancer in the elderly: safety, feasibility and short-term outcomes.
abstract: BACKGROUND
  Standard oncologic liver resections performed on elderly patients (≥70 years old) have been shown to be safe and effective. The aim of this study was to analyze operative and oncologic short-term outcomes of totally laparoscopic liver resections (TLLR) performed on elderly patients for malignancies.
  
  
  METHODS
  We performed a retrospective statistical analysis of prospectively recorded data of TLLR performed from October 2008 to February 2012 by a single hepato-pancreato-biliary (HPB) surgeon. Patients were divided into two groups according to age (<70 vs. ≥ 70 years old) and perioperative outcomes were compared.
  
  
  RESULTS
  A total of 60 TLLR for malignancies were identified of which 25 patients (42 %) were aged ≥ 70 years (Group A) and 35 (58 %) were aged <70 years (Group B). There was no difference in operative time (170 vs. 180 min, p = 0.267), median blood loss (200 vs. 250 ml, p = 0.183), number and time of Pringle maneuver (p = 0.563 and p = 0.180), blood transfusion rate (4 vs. 17 %, p = 0.222), conversion rate (4 vs. 9 %, p = 0.443), morbidity rate (12 vs. 20 %, p = 0.797), and perioperative mortality rate (0 vs. 3 %, p = 0.688). An R0 resection was achieved in 92 (Group A) versus 83 % (Group B) (p = 0.265). At a median follow-up of 18 months, 12 % of patients in Group A experienced a disease recurrence with a related mortality rate similar to that of Group B (8 vs. 12 %, p = 0.375).
  
  
  CONCLUSIONS
  This retrospective comparative study shows that TLLR performed on elderly for liver neoplasm are feasible and safe and lead to short-term outcomes similar to those of younger patients.
authors.affiliation: HPB and Advanced Laparoscopic Surgical Unit, Department of General and Minimally Invasive Surgery, Policlinic of Abano Terme, Piazza C. Colombo 1, 35031, Abano Terme, PD, Italy. marcello.spampinato@gmail.com
authors.forename: Marcello Giuseppe
authors.initials: MG
authors.lastname: Spampinato
authors.forename: Marianna
authors.initials: M
authors.lastname: Arvanitakis
authors.forename: Francesco
authors.initials: F
authors.lastname: Puleo
authors.forename: Lucio
authors.initials: L
authors.lastname: Mandala
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quarta
authors.forename: Donatella
authors.initials: D
authors.lastname: Traisci
authors.forename: Antonella
authors.initials: A
authors.lastname: Plaia
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Bartolomeo
authors.forename: Giànandrea
authors.initials: G
authors.lastname: Baldazzi
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome