title: A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation.
abstract: Liver resection is the treatment option with the best chance for cure in patients with malignant liver tumors. However, there are concerns regarding postoperative recovery in elderly patients, which may lead to a preference of non-resectional therapies over hepatectomy in this patient population. Although laparoscopic liver resection (LLR) is associated with a faster recovery compared to open hepatectomy, there are scant data on how elderly patients tolerate LLR. The aim of this study was to analyze the perioperative outcomes of LLR in elderly patients with hepatic malignancies, with a comparison to laparoscopic RFA (LRFA).
  
  
  
  A retrospective analysis of a prospective database for liver tumors identified a total of 82 patients older than 65 years who underwent laparoscopic treatment of their liver tumors in a single tertiary care center between 2000 and 2014. These patients were equally distributed into LLR and LRFA treatment arms.
  
  
  
  Mean age, American Society of Anesthesiologists (ASA) score and tumor type (predominantly metastatic colorectal cancer) were similar in both groups. Patients in the LRFA group had more tumors (2.1 ± 1.8 vs. 1.2 ± 0.6, p < 0.01), whereas tumors were larger in the LLR group (3.8 ± 1.6 vs. 2.8 ± 1.1 cm, p < 0.01). Although the operative time (116 vs. 214 min, p < 0.01) and hospital stay (2.1 vs. 3.4 days, p = 0.010) were shorter for the LRFA versus LLR group, respectively, morbidity (4.8 vs. 7.3 %) and mortality (0 vs. 0 %) were similar. Local recurrence was significantly higher in the LRFA versus LLR group (29 vs. 2.4 %, respectively, p = 0.002). However, there was no statistical difference in disease-free and overall survival between two groups (28 vs. 30 and 51 vs. 54 months, p = 0.443 and 0.768, respectively).
  
  
  
  This study showed that LLR was tolerated as well as LRFA in elderly patients with similar comorbidities. We suggest LLR to be considered as an option in selected elderly patients who are deemed poor candidates for open hepatectomy.
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Pinar
authors.initials: P
authors.lastname: Yazici
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Muhammet
authors.initials: M
authors.lastname: Akyuz
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Hakan
authors.initials: H
authors.lastname: Yigitbas
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Cem
authors.initials: C
authors.lastname: Dural
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Okoh
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
authors.forename: Nail
authors.initials: N
authors.lastname: Aydin
authors.affiliation: Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA. berbere@ccf.org.
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D017115:Catheter Ablation; D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D012189:Retrospective Studies
keywords: Geriatric patients; Hepatic tumor; Laparoscopic liver resection; Laparoscopic radiofrequency ablation