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. 2022 Nov 14:12:939877.
doi: 10.3389/fonc.2022.939877. eCollection 2022.

Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies

Shi Wang  1 , Guanxiong Ye  1 , Jun Wang  1 , Shengqian Xu  1 , Qiaoping Ye  1 , Hailin Ye  1
Affiliations

Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: A systematic review and meta-analysis of propensity score-matched studies

Shi Wang et al. Front Oncol. .

Abstract

Purpose: Laparoscopic liver resection (LLR) is a widely practiced therapeutic method and holds several advantages over open liver resection (OLR) including less postoperative pain, lower morbidity, and faster recovery. However, the effect of LLR for the treatment of hepatocellular carcinoma (HCC) in elderly patients remains controversial. Therefore, we aimed to perform the first meta-analysis of propensity score-matched (PSM) studies to compare the short- and long-term outcomes of LLR versus OLR for elderly patients with HCC.

Methods: Databases including PubMed, Embase, Scopus, and Cochrane Library were systematically searched until April 2022 for eligible studies that compared LLR and OLR for the treatment of HCC in elderly patients. Short-term outcomes include postoperative complications, blood loss, surgical time, and length of hospital stay. Long-term outcomes include overall survival (OS) rate and disease-free survival (DFS) rate at 1, 3, and 5 years.

Results: A total of 12 trials involving 1,861 patients (907 in the LLR group, 954 in the OLR group) were included. Compared with OLR, LLR was associated with lower postoperative complications (OR 0.49, 95% CI 0.39 to 0.62, P < 0.00001, I 2 = 0%), less blood loss (MD -285.69, 95% CI -481.72 to -89.65, P = 0.004, I 2 = 96%), and shorter hospital stay (MD -7.88, 95% CI -11.38 to -4.37, P < 0.0001, I 2 = 96%), whereas operation time (MD 17.33, 95% CI -6.17 to 40.83, P = 0.15, I 2 = 92%) was insignificantly different. Furthermore, there were no significant differences for the OS and DFS rates at 1, 3, and 5 years.

Conclusions: For elderly patients with HCC, LLR offers better short-term outcomes including a lower incidence of postoperative complications and shorter hospital stays, with comparable long-term outcomes when compared with the open approach. Our results support the implementation of LLR for the treatment of HCC in elderly patients.

Systematic review registration: https://inplasy.com/inplasy-2022-4-0156/, identifier INPLASY202240156.

Keywords: elderly; hepatocellular carcinoma (HCC); laparoscopic liver resection (LLR); meta-analysis; open liver resection (OLR).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for the meta-analysis.
See this image and copyright information in PMC

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References

    1. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. . Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet (Lond Engl) (2018) 391(10125):1023–75. doi: 10.1016/S0140-6736(17)33326-3 - DOI - PMC - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, et al. . Hepatocellular carcinoma. Nat Rev Dis Primers (2021) 7(1):6. doi: 10.1038/s41572-020-00240-3 - DOI - PubMed
    1. Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M. Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet (2017) 389(10076):1323–35. doi: 10.1016/S0140-6736(16)32381-9 - DOI - PMC - PubMed
    1. Reich H, McGlynn F, DeCaprio J, Budin R. Laparoscopic excision of benign liver lesions. Obstet Gynecol (1991) 78(5 Pt 2):956–8. - PubMed

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