The efficacy and safety of totally laparoscopic hepatectomy for non-cirrhotic hepatocellular carcinoma in the elderly

BACKGROUND: Laparoscopic hepatectomy (LH) has been identified to be effective and safe for elderly patients (≥70 years). This study aims to assess the short-and long-term outcome of totally laparoscopic liver resection for elderly patients with Hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed 93 patients with HCC who underwent LH from August, 2003 to July, 2013 in a single center. Short-term operative and postoperative outcomes together with long-term outcomes, including disease free survival (DFS) and overall survival (OS) were analyzed. RESULTS: A total of 81 patients was finally reviewed, of which 23 patients (28.40%) were grouped to elderly (≥70 years) and 58 patients (71.60%) were divided into younger group (< 70 years). The mean ages of patients in the elderly and younger cohorts were 74.9 ± 3.4 and 50.9 ± 12.7 years old, respectively. The median follow-up durations in elderly cohort and young cohort were 30 months and 24 months. The mean postoperative hospital stay was nearly 4 days longer in the elderly cohort than that in younger group (13.4 vs 9.5; p = 0.003). The elderly cohort has a higher rate of non-surgical complications than that in the younger cohort (P = 0.045), while the risks of surgical complications were comparable between the two groups. For the postoperative complications, elderly patients were more easily to develop grade III or more of Clavien-Dindo classification than that in the younger patients (P = 0.008). The median OS in the elderly group and younger group was 44.09 months and 42.49 months, respectively, with p = 0.089. The median DFS in the elderly group and the younger group was 39.87 months and 37.86 months, respectively, with p = 0.0616. CONCLUSIONS: Elderly patients could obtain comparable operative and survival benefits from LH for HCC as younger counterparts. Age may not be a contraindication to laparoscopic liver resection for elderly patients.