• François Cauchy, David Fuks, Takeo Nomi, Safi Dokmak, Olivier Scatton, Lilian Schwarz, Louise Barbier, Jacques Belghiti, Olivier Soubrane, and Brice Gayet.
• Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Saint Antoine, University Pierre et Marie Curie, Paris, France; Department of Digestive and HPB Surgery, Hôpital de la Pitié Salpétrière, University Denis Diderot, Paris, France; Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France.
• J. Am. Coll. Surg. 2016 Feb 1; 222 (2): 174-84.e10.

BackgroundAlthough recent reports have suggested the potential advantages of laparoscopy in patients undergoing major hepatectomy, the benefits of this approach in elderly patients remain unclear. This study aimed to compare the short-term outcomes of laparoscopic major hepatectomy (LMH) and open major hepatectomy (OMH) in elderly patients.Study DesignAll patients aged 55 years and older undergoing laparoscopic LMH between 2000 and 2013 at 2 centers were retrospectively analyzed and divided into 3 groups (group 1: 55 to 64 years old; group 2: 65 to 74 years old; and group 3: 75 years and older). Risk factors for postoperative complications were determined on multivariable analysis in the overall LMH population and in each LMH group. Outcomes of LMH patients were compared with those of patients of similar age undergoing OMH at another center after propensity score matching.ResultsLaparoscopic major hepatectomy was performed in 174 patients, including 72 (41.4%) in group 1, 67 (38.5%) in group 2, and 35 (20.1%) in group 3. On multivariable analysis, diabetes (odds ratio [OR] = 2.349; 95% CI, 1.251-2.674; p = 0.047), American Society of Anesthesiologists status (OR = 2.881; 95% CI, 2.193-3.71; p = 0.017), cirrhosis (OR = 1.426; 95% CI, 1.092-2.025; p = 0.043), right-sided resection (OR = 2.001; 95% CI, 1.492-2.563; p = 0.037), conversion (OR = 1.950; 95% CI, 1.331-2.545; p = 0.024), and intraoperative transfusion (OR = 2.338, 95% CI, 1.738-2.701, p = 0.032) were associated with increased risk of postoperative complications in the whole LMH population. After propensity score matching, laparoscopy was associated with significantly decreased rates of pulmonary complications and shorter hospital stays in all groups, decreased rates of overall complications in group 2 and group 3, and decreased rates of postoperative confusion in group 3.ConclusionsThe current study supports the benefits of laparoscopy in decreasing postoperative complications in elderly patients requiring major hepatectomy.Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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