ArticleSurgical endoscopy2026
A multicenter case-controlled study on laparoscopic hepatectomy versus open liver resection as first-line therapy for solitary hepatocellular carcinoma in elderly patients.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to compare perioperative and long-term outcomes between laparoscopic (LLR) and open liver resection (OLR) in elderly patients with solitary hepatocellular carcinoma (HCC).
methodsThe study consecutively included patients aged ≥ 70 years who underwent curative liver resection for single HCC at four tertiary centers between January 2015 and December 2021. Perioperative short-term and long-term survival outcomes were compared between the LLR and OLR groups. Propensity score matching (PSM) was performed in a 1:1 ratio to balance baseline characteristics between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent risk factors associated with overall survival (OS) and recurrence-free survival (RFS).
resultsOf the 180 patients, 94 and 86 were included in the LLR and OLR groups, respectively. After PSM, 65 patients were included in each group. Intraoperative blood loss (p = 0.010), operative time (p = 0.021), length of hospital stay (p = 0.021) and 90-day readmission rate (p = 0.048) were significantly lower in the matched LLR than the matched OLR group. Moreover, postoperative ascites complication was less frequent in the matched LLR group (p = 0.046). Long-term survival outcomes were better in the LLR group compared with the OLR group both before and after PSM (for OS: p = 0.019 and 0.003; for RFS: p = 0.023 and 0.012). Multivariate Cox regression analysis found that open hepatectomy was an independent risk factor of OS and RFS for elderly HCC patients compared to laparoscopic approach.
conclusionFor selected elderly patients with solitary HCC, particularly those with tumors in locations amenable to a minimally invasive approach, LLR was associated with superior perioperative and long-term survival outcomes compared to OLR. CLINICAL TRIALS REGISTRATION: Not applicable because this is a retrospective observational study.
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