title: Pure Laparoscopic Versus Open Liver Resection for Primary Liver Carcinoma in Elderly Patients: A Single-Center, Case-Matched Study.
abstract: Pure laparoscopic liver resection (PLLR) has been reported to be as safe and effective as open liver resection (OLR) for liver lesions, and it is associated with less intraoperative blood loss, shorter hospital stay, and lower complication rate. However, studies comparing PLLR with OLR in elderly patients were limited. The aim of this study was to analyze the short-term outcome of PLLR versus OLR for primary liver carcinoma (PLC) in elderly patients.Between January 2008 and October 2014, 30 consecutive elderly patients (≥70 years) who underwent PLLR for PLC were included into analysis. Sixty patients who received OLR for PLC during the same study period were also included as a case-matched control group. Patients were well matched in terms of age, sex, comorbid illness, Child Pugh class, American Society of Anesthesiologists grade, tumor size, tumor location, and extent of hepatectomy.No significant differences were observed with regard to patient preoperative baseline status, median tumor size (Group PLLR 4.0 cm vs Group OLR 5.0 cm, P = 0.125), tumor location, extent of hepatectomy, and operation time (Group PLLR 133 minutes vs Group OLR 170 minutes, P = 0.073). Compared with OLR, the PLLR group displayed a significantly less frequent Pringle maneuver application (10.0% vs 70.0%, P < 0.001), less blood loss (100 vs 300 mL; P < 0.001), shorter hospital stay (5 vs 10 days; P < 0.001), and lower total hospitalization cost ($9147.50 vs $10,867.10, P = 0.008). The postoperative complication rates were similar between groups (Group PLLR 10.0% vs Group OLR 16.7%; P = 0.532). There was no hospital mortality in both groups.PLLR for PLC is as safe and feasible as OLR, but with less blood loss, shorter hospital stay, and lower hospitalization cost for selected elderly patients.
authors.affiliation: From the Department of Hepatobiliary Surgery (X-TW, H-GW, W-DD, M-YC, HL, XH, F-B, J-HD), Chinese PLA General Hospital, Beijing; School of Medicine (X-TW, XH, F-B, J-HD), Nankai University, Tianjin; and Institute of Systems Biomedicine (C-YW), Peking University, Beijing, China.
authors.forename: Xi-Tao
authors.initials: XT
authors.lastname: Wang
authors.forename: Hong-Guang
authors.initials: HG
authors.lastname: Wang
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Duan
authors.forename: Cong-Ying
authors.initials: CY
authors.lastname: Wu
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Chen
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Huang
authors.forename: Fu-Bo
authors.initials: FB
authors.lastname: Zhang
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies