Table 3 - uploaded by Marcello G. Spampinato
Content may be subject to copyright.
Source publication
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 retrospect...
Context in source publication
Similar publications
Background
Laparoscopic hepatectomy has presented great importance for treating malignant hepatic lesions.
Aim
To evaluate its impact in relation to overall survival or disease free of the patients operated due different hepatic malignant tumors.
Methods
Thirty-four laparoscopic hepatectomies were performed in 31 patients with malignant neoplasm....
Citations
... However, it is still unclear whether LLR can provide the same benefits in elderly patients as in non-elderly patients. Until date, little evidence has been established of the safety and feasibility of LLR in elderly patients as compared to non-elderly patients [13,[17][18][19][20]. In addition, reported evidence so far is also limited by factors such as a small sample size or non-recent data [13,[17][18][19][20]. ...
... Until date, little evidence has been established of the safety and feasibility of LLR in elderly patients as compared to non-elderly patients [13,[17][18][19][20]. In addition, reported evidence so far is also limited by factors such as a small sample size or non-recent data [13,[17][18][19][20]. Therefore, we conducted an analysis of the most recent data obtained from studies with sample sizes of > 100 each, to investigate the short-term outcomes of LLR in elderly patients as compared to nonelderly patients. ...
... In the present study, we obtained comparable surgical outcomes between elderly patients and non-elderly patients who had undergone LLR, including in terms of the operation time, blood loss, blood transfusion volume, rate of conversion to open surgery or HALS, incidence of Clavien-Dindo grade ≥ IIIa postoperative morbidities, and 30-day mortality. Previous studies have also reported similar outcomes [13,[17][18][19][20]. These results indicate that elderly patients can obtain as much benefit from LLR as non-elderly patients. ...
Background
The indications of laparoscopic liver resection (LLR) have expanded to high-risk patients, such as elderly people. However, to date, little evidence has been established of the safety and feasibility of LLR in elderly patients. The short-term outcomes of LLR in elderly patients as compared to non-elderly patients were investigated.
Methods
Data of a total of 297 patients who underwent LLR were reviewed. Among these 297 patients, 181 patients were < 75 years age (non-elderly) and 116 patients were ≥ 75 years age (elderly), and the surgical outcomes were compared between the groups. In addition, we evaluated the risk factors for postoperative morbidity (Clavien-Dindo grade ≥ IIIa) utilizing the preoperative, operative, and postoperative variables
Results
The preoperative liver/renal function, frequency of anti-thrombotic drug use, number of comorbidities, and American Society of Anesthesiologists-physical status classification were more unfavorable in elderly patients than in non-elderly patients. No significant inter-group differences were observed in the operation time, blood loss, conversion rate, postoperative morbidity, or 30-day mortality. The 3-year overall survival rate was comparable between the two groups. Multivariate analysis identified anti-thrombotic drug use, operation time > 7 h, and peak serum total bilirubin > 2 mg/dl within postoperative day 3 as independent risk factors for Clavien-Dindo ≥ IIIa postoperative morbidity (P = 0.016, P < 0.001, and P = 0.001, respectively).
Conclusions
LLR in elderly patients may provide comparable short-term outcomes to those in non-elderly patients.
... The role of laparoscopic approach in the management of HCC in elderly patients remains uncertain. Limited data in terms of oncological outcome and long-term survival has been reported in this population [18][19][20][21] . Historically, advanced age and presence of comorbid diseases have excluded patients from liver surgery. ...
Aim: To elucidate the role and efficacy of laparoscopic liver resection for elderly patients with hepatocellular carcinoma (HCC).
Methods: A retrospective comparative analysis was performed between laparoscopic and open liver resection operated from year 2008 to 2018. Consecutive HCC patients aged 65 or above at the time of operation were recruited. Patients with recurrent HCC and/or alternative pathology were excluded. Short-term and long-term outcomes between the laparoscopic and the open group were compared. Propensity score matching of patients in a ratio of 1:2 was conducted before comparison.
Results: A total of 911 patients underwent hepatectomy for primary HCC from 2008 to 2018. Among them, 320 elderly patients aged over 65 years old were eligible for analysis. Heterogeneities between laparoscopic and open groups were identified namely pre-operative albumin level, aspartate transaminase, and magnitude of hepatectomy (major vs. minor). After propensity score matching of 1:2, 46 patients in the laparoscopic group and 92 patients in the open group were included for comparison. The laparoscopic group had less blood loss (326 mL vs. 735 mL; P < 0.001), shorter operative time (223 min vs. 324 min; P < 0.001), and shorter hospital stay (6.3 days vs. 10.5 days; P < 0.001). No significant differences in postoperative morbidity and hospital mortality were noted between the groups. For oncological outcome, the laparoscopic group had a superior disease-free survival (59.7% vs. 44.5%; P = 0.041), and a trend towards better overall survival compared with the open group. (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.
... Many studies have reported that LLR showed improved surgical and postoperative outcomes. 6,13,[20][21][22] With these evidences, the indications for LLR have been expanded to malignancies and major hepatectomies, and further studies have proven the safety and acceptable morbidity and mortality rates of LLR. Also, advancements in postoperative care and improvements in laparoscopic instruments have made LLR more feasible for the treatment of neoplastic liver disease. ...
Purpose:
The aim of this study was to compare the short-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) in elderly patients with hepatic tumors.
Methods:
From January 2013 to December 2019, a retrospective study was conducted for a total of 143 patients with over 70 years of age, who underwent liver resection for hepatic tumors. Forty-five patients who received biliary reconstruction at the same time were excluded. According to surgical approaches, 98 patients were classified into LLR and OLR groups. All postoperative complications were classified according to the Clavien-Dindo grading system and the Comprehensive Complication Index (CCI).
Results:
Incidence of the postoperative complications was not statistically different between LLR and OLR groups. The CCI was significantly lower in the LLR group, with a median of 8.556, and a median of 19.698 in the OLR group (p=0.042). The length of hospital stay in the LLR group was significantly shorter than in the OLR group (p=0.008).
Conclusion:
LLR is safe and feasible as a treatment for hepatic tumor in elderly patients with potentially less postoperative complications compared to OLR.
... Over the past 5 years, some single-center retrospective studies have focused on the results of LLR in elderly patients [10][11][12][13][14][15][16][17][18]. Two different strategies were implemented: (1) comparison between the laparoscopic and open approaches in the elderly; and (2) comparison between the elderly and non-elderly population after laparoscopic liver resection. ...
... However, our study is limited, due to the lack of analysis regarding comparable populations and the absence of randomized perspective studies, except for Martinez-Cecilia et al. in 2017. In addition, in the selected articles, long-term OS and DFS were not systematically reported (only by Spampinato in 2012 [16] and Nomi, 2014 [15] in Group 2, and by Badawy in 2017 [11], and by Martinez-Cecilia in 2017 [14], in Group 1). Another point to consider is the extensive period of time during which data were collected, i.e., from the introduction to the latest experience in LLR. ...
Laparoscopic liver resection (LLR) is becoming standard practice, replacing the open approach in terms of safety and feasibility. However, few data are available for the elderly. The objective of this study is to assess the feasibility of LLR in elderly patients, by making a comparison with open liver resection (OLR) and with non-elderly patients. Relevant studies found in the Cochrane Library, Embase, PubMed, and Web of Science were used in order to perform a systematic review and meta-analysis. Nine fully extracted comparative studies were included and two groups were identified: Group 1 with a comparison between OLR and LLR in the elderly and Group 2 with a focus on differences after LLR between elderly and non-elderly patients. A total number of 497 elderly patients who underwent LLR were analyzed. A random effect model was used for the meta-analysis. In Group 1, 1025 elderly patients were included: 640 underwent OLR and 385 underwent LLR. LLR was associated with minor blood loss (MD − 240 mL, 95% CI − 416.61, − 63.55; p 0.008; I² = 96%), less transfusion (8% vs. 13.1%; RR 0.61, 95% CI 0.41, 0.91; p = 0.02; I² = 0%), fewer postoperative Clavien-Dindo III/IV complications (RR 0.48 in favor of LLR; 95% CI 0.29, 0.77; p = 0.003; I² = 0%). On the other hand, no significant difference was observed in terms of bile leakage, ascites, mortality, liver failure, or R0 resection. Group 2 included 112 elderly and 276 non-elderly patients who underwent LLR. The meta-analysis showed no significant difference in terms of blood loss, transfusions, liver failure, Clavien-Dindo III/IV complications, postoperative mortality, ascites, bile leak, hospital stay, R0 resection, and operative time. Laparoscopic liver resection is a safe and feasible procedure for elderly patients. However, further randomized studies are required to confirm this.
... [10][11][12][13][14][15] However, the previous studies have not included large numbers of elderly patients, and only a few English reports have described LH treatment for CRLM. [16][17][18][19] Furthermore, there is a lack of studies comparing short-and long-term outcomes of LH treatment between elderly and middle-aged patients with CRLM. Therefore, the present study aimed to compare the short-and long-term outcomes of LH treatment among elderly and middle-aged patients with CRLM. ...
Purpose
This study aimed to evaluate the short- and long-term outcomes of laparoscopic hepatectomy (LH) for colorectal liver metastases (CRLM) in elderly patients.
Patients and methods
Between January 2009 and January 2016, LH was performed for 241 consecutive patients who were ≥60 years old and had CRLM. Based on their age at the LH, the patients were divided into an elderly group (≥70 years old, 78 patients) and a middle-aged group (60–69 years old, 163 patients). The short- and long-term outcomes were compared between the two groups.
Results
Compared to the middle-aged group, the elderly group had higher values for Charlson comorbidity index, proportion of preoperative chemotherapy, and American Society of Anesthesiologists score. No other significant differences were observed in the preoperative characteristics. The elderly group had a higher conversion rate, compared to the middle-aged group, although no significant differences were observed in the surgical procedures, surgical times, intraoperative blood losses, numbers and severities of postoperative 90-day complications, postoperative 90-day mortality rates, pathology results, and other short-term outcomes. Long-term follow-up revealed similar rates of recurrence, disease-free survival, and overall survival in the two groups. Multivariable analysis revealed that age did not independently predict overall survival or disease-free survival.
Conclusion
Similar short- and long-term outcomes were observed after LH for CRLM in elderly and middle-aged patients. Thus, advanced age is not a contraindication for LH treatment in this setting.
... LMH was associated with the significantly decreased frequency of pulmonary complications and shorter length of stay at the expense of an increase in blood loss and longer operation time. The increase in blood loss was contrary to previous studies on LMH and OMH for elderly patients which reported either a decrease or no difference in blood loss associated with LMH [1,2,13,[20][21][22]. However, none of these studies focused specifically on LMH for HCC. ...
Introduction:
This study aims to evaluate the safety and feasibility of laparoscopic minor hepatectomy (LMH) in elderly patients with hepatocellular carcinoma (HCC).
Methods:
A total of 40 consecutive elderly (≥ 70 years) patients were compared with 94 young patients (< 70 years). The 40 patients were also compared with 85 consecutive elderly patients who underwent open minor hepatectomies (OMH). After 1:1 propensity-score matching (PSM), 32 LMHs were compared with 32 OMHs in elderly patients.
Results:
Comparison between the baseline characteristics of elderly and young HCC patients showed that elderly patients were significantly more likely to have comorbidities, ASA score > 2, non-hepatitis B, previous liver resection and larger tumor size. Comparison between perioperative outcomes demonstrated that elderly patients were significantly more likely to have a longer operation time, increased blood loss, increased need for blood transfusion, longer Pringles duration and longer postoperative stay. Comparison between LMH and OMH in elderly patients demonstrated no significant difference in baseline characteristics except the LMH cohort were significantly more likely to have > 1 comorbidity, higher platelet count and lower median AFP level. Comparison between outcomes before and after PSM demonstrated that LMH was associated with longer operation time, increased blood loss, longer Pringles duration but decreased postoperative pulmonary complications and shorter postoperative stay compared to OMH.
Conclusion:
LMH is safe and feasible in elderly patients with HCC. However, LMH in elderly patients is associated with poorer perioperative outcomes compared to LMH in young patients. Comparison between LMH and OMH in elderly patients demonstrated advantages in terms of decreased pulmonary complications and shorter length of stay at the expense of increased operation time and blood loss.
... The number of elderly pa-tients with HCC is gradually increasing, and open hepatectomy presents a higher surgical risk for this patient group [9][10][11][12]. In recent years, LH has been gradually carried out in elderly patients with HCC [36][37][38][39][40][41][42], and studies indicate that LH can achieve lower complications, less blood loss, and shorter hospital stay than open hepatectomy [36][37][38][39][40][41][42]. Thus, LH is safe and feasible in elderly patients with HCC. ...
... The number of elderly pa-tients with HCC is gradually increasing, and open hepatectomy presents a higher surgical risk for this patient group [9][10][11][12]. In recent years, LH has been gradually carried out in elderly patients with HCC [36][37][38][39][40][41][42], and studies indicate that LH can achieve lower complications, less blood loss, and shorter hospital stay than open hepatectomy [36][37][38][39][40][41][42]. Thus, LH is safe and feasible in elderly patients with HCC. ...
Purpose:
To compare short- and long-term outcomes of laparoscopic hepatectomy (LH) in elderly and non-elderly patients with hepatocellular carcinoma (HCC).
Methods:
Clinical and follow-up data of patients with HCC who underwent LH in our Institute from January 2011 to December 2016 were retrospectively analyzed. The patients were divided into elderly (48 cases, 70 years old or older) or non-elderly group (97 cases, <70 years) according to their age at the time of operation. The short- and long-term outcomes of both groups were compared.
Results:
The Charlson comorbidity index and American Society of Anesthesiologists (ASA) score of patients in the elderly group were higher than those of patients in the nonelderly group, and the rates of hepatitis virus infection and cirrhosis in the elderly group were lower than those in the non-elderly group. The rest of the preoperative data showed no statistical significance. Short-term outcomes, including operation time, intraoperative blood loss, transfer rate, length of hospital stay, incidence of complications and their severity within 30 days after surgery, and pathological findings, showed no significant difference between the elderly and non-elderly groups. Recurrence rates, treatment of the recurrence, overall survival (OS) rates, and disease-free survival (DFS) rates were similar in both groups. Multivariate analysis showed that age was not an independent predictor of OS and DFS.
Conclusions:
LH in elderly patients can achieve short- and long-term outcomes similar to those in non-elderly patients with liver cancer. Old age is not a contraindication for LH in patients with HCC.
... [16,17] Finally, 9 studies were selected for further meta-analysis. [18][19][20][21][22][23][24][25][26] Of these, 5 studies compared LH and OH among elderly patients, [22][23][24][25][26] 3 evaluated the safety and feasibility of LH among elderly patients compared to nonelderly patients also receiving LH [18][19][20] and 1 compared the outcomes of LH for both elderly patients with nonelderly patients to LH and OH among elderly patients. [21] No randomized controlled trial (RCT) was found. ...
... [16,17] Finally, 9 studies were selected for further meta-analysis. [18][19][20][21][22][23][24][25][26] Of these, 5 studies compared LH and OH among elderly patients, [22][23][24][25][26] 3 evaluated the safety and feasibility of LH among elderly patients compared to nonelderly patients also receiving LH [18][19][20] and 1 compared the outcomes of LH for both elderly patients with nonelderly patients to LH and OH among elderly patients. [21] No randomized controlled trial (RCT) was found. ...
... [21,26] Five studies were case-matched research studies. [19,[22][23][24]26] Five studies used 70 years as the age cutoff the elderly label, [18,19,22,23,26] whereas 1 study used 65 years [24] and the other 3 studies used 75. [20,21,25] The indications of 2 studies included benign liver lesions and malignancy. ...
Background
As the general population continues to age, there is an increase need for surgical management of elderly patients. Compared to open hepatectomy (OH), laparoscopic hepatectomy (LH) offers earlier mobilization, less blood loss, and shorter postoperative hospital stay. However, whether these advantages of LH over OH are retained in elderly patients remains to be clarified. Therefore, in this study, we sought to evaluate the feasibility, safety, and potential benefits of LH for elderly patients.
Methods
A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared LH and OH. Studies comparing LH in elderly and LH in nonelderly patients were also identified. Outcomes of interest included conversion rate, operative time, intraoperative estimated blood loss, length of hospital stay, rate and type of morbidity, mortality rate, margin status (R0), and long-term oncologic outcomes.
Results
Nine studies met our inclusion criteria for this analysis. Of these, 5 compared LH and OH in elderly patients, 3 compared LH in elderly and nonelderly patients, and 1 included both outcomes. Compared to those with OH, elderly patients who underwent LH had similar operative times [weighted mean difference (WMD) = 1.15 minutes; 95% confidence interval (CI): −28.28–30.59, P = .94], less intraoperative blood loss (WMD = −0.71 mL; 95% CI: −1.29 to −0.16, P = .01), a lower rate of transfusion [risk ratio (RR) = 0.61, 95% CI: 0.40–0.94, P = .02], comparable R0 rates (RR = 1.01; 95% CI: 0.96–1.07, P = .70), less postoperative complications (RR = 0.61, 95% CI: 0.48–0.76, P < .01), and shorter hospital stay (WMD = −3.22 days; 95% CI: −4.21 to −2.23, P < .01). The limited long-term outcomes indicated that survival status was comparable between LH and OH for elderly patients. The pooled outcomes for elderly versus nonelderly patients indicated that the safety and effectiveness of LH over OH in elderly patients was not inferior to those in nonelderly patients.
Conclusion
Our results indicate that LH is a feasible and safe alternative to OH in elderly patients, providing a lower rate of morbidity and favorable postoperative recovery and outcomes.
... Elderly patients are generally defined as those over the age of 65 years. However, there is no general agreement on this definition with many publications considering those over 70 years as elderly 16,17,[30][31][32][33] with more recent publications suggesting 75 years. 34,35 This lack of a standard definition could lead to generic conclusions being drawn with subsequent inaccurate guidance in this population. ...
Objective:
This study aims to compare the perioperative and oncological outcomes of laparoscopic and open liver resection for colorectal liver metastases in the elderly.
Background:
Laparoscopic liver resection has been associated with less morbidity and similar oncological outcomes to open liver resection for colorectal liver metastases (CRLMs). It has been reported that these benefits continue to be observed in elderly patients. However, in previous studies, patients over 70 or 75 years were considered as a single, homogenous population raising questions regarding the true impact of the laparoscopic approach on this diverse group of elderly patients.
Method:
Prospectively maintained databases of all patients undergoing liver resection for CRLM in 5 tertiary liver centers were included. Those over 70-years old were selected for this study. The cohort was divided in 3 subgroups based on age. A comparative analysis was performed after the implementation of propensity score matching on the 2 main cohorts (laparoscopic and open groups) and also on the study subgroups.
Results:
A total of 775 patients were included in the study. After propensity score matching 225 patients were comparable in each of the main groups. Lower blood loss (250 vs 400 mL, P = 0.001), less overall morbidity (22% vs 39%, P = 0.001), shorter High Dependency Unit (2 vs. 6 days, P = 0.001), and total hospital stay (5 vs. 8 days, P = 0.001) were observed after laparoscopic liver resection. Comparable rates of R0 resection (88% vs 88%, P = 0.999), median recurrence-free survival (33 vs 27 months, P = 0.502), and overall survival (51 vs 45 months, P = 0.671) were observed. The advantages seen with the laparoscopic approach were reproduced in the 70 to 74-year old subgroup; however there was a gradual loss of these advantages with increasing age.
Conclusions:
In patients over 70 years of age laparoscopic liver resection, for colorectal liver metastases, offers significant lower morbidity, and a shorter hospital stay with comparable oncological outcomes when compared with open liver resection. However, the benefits of the laparoscopic approach appear to fade with increasing age, with no statistically significant benefits in octogenarians except for a lower High Dependency Unit stay.
... Surgical treatment in the so called "elderly" patients has been extensively reported even for oncological diseases either by laparotomy or laparoscopy [28,29]. ...
Background:
Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life.
Methods:
Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication.
Results:
Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG).
Conclusions:
In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
