title: Benefits of Laparoscopy in Elderly Patients Requiring Major Liver Resection.
abstract: BACKGROUND
  Although recent reports have suggested the potential advantages of laparoscopy in patients undergoing major hepatectomy, the benefits of this approach in elderly patients remain unclear. This study aimed to compare the short-term outcomes of laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients.
  
  
  METHODS
  All patients aged 55 years and older undergoing laparoscopic LMH between 2000 and 2013 at 2 centers were retrospectively analyzed and divided into 3 groups (group 1: 55 to 64 years old; group 2: 65 to 74 years old; and group 3: 75 years and older). Risk factors for postoperative complications were determined on multivariable analysis in the overall LMH population and in each LMH group. Outcomes of LMH patients were compared with those of patients of similar age undergoing OMH at another center after propensity score matching.
  
  
  RESULTS
  Laparoscopic major hepatectomy was performed in 174 patients, including 72 (41.4%) in group 1, 67 (38.5%) in group 2, and 35 (20.1%) in group 3. On multivariable analysis, diabetes (odds ratio [OR] = 2.349; 95% CI, 1.251-2.674; p = 0.047), American Society of Anesthesiologists status (OR = 2.881; 95% CI, 2.193-3.71; p = 0.017), cirrhosis (OR = 1.426; 95% CI, 1.092-2.025; p = 0.043), right-sided resection (OR = 2.001; 95% CI, 1.492-2.563; p = 0.037), conversion (OR = 1.950; 95% CI, 1.331-2.545; p = 0.024), and intraoperative transfusion (OR = 2.338, 95% CI, 1.738-2.701, p = 0.032) were associated with increased risk of postoperative complications in the whole LMH population. After propensity score matching, laparoscopy was associated with significantly decreased rates of pulmonary complications and shorter hospital stays in all groups, decreased rates of overall complications in group 2 and group 3, and decreased rates of postoperative confusion in group 3.
  
  
  CONCLUSIONS
  The current study supports the benefits of laparoscopy in decreasing postoperative complications in elderly patients requiring major hepatectomy.
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France; Department of Digestive Disease, Institut Mutualiste Montsouris, University René Descartes, Paris, France. Electronic address: davidfuks80@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France; Department of Digestive Disease, Institut Mutualiste Montsouris, University René Descartes, Paris, France.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nomi
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
authors.forename: Safi
authors.initials: S
authors.lastname: Dokmak
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France.
authors.forename: Lilian
authors.initials: L
authors.lastname: Schwarz
authors.affiliation: Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Barbier
authors.affiliation: Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Department of Digestive Disease, Institut Mutualiste Montsouris, Paris, France; Department of Digestive Disease, Institut Mutualiste Montsouris, University René Descartes, Paris, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Gayet
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome