TY - JOUR
T1 - Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis
AU - Hildebrand, N.
AU - Verkoulen, K.
AU - Dewulf, M.
AU - Heise, D.
AU - Ulmer, F.
AU - Coolsen, M.
N1 - Funding Information:
The authors thank the Department of Methodology and Statistics of Maastricht University for advices on the statistical analyses and Prof. C.H.C. Dejong for his comments on the manuscript.
Publisher Copyright:
© 2021 The Author(s)
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Background and aim: Favorable outcomes of laparoscopic hepatectomy (LH) over open hepatectomy (OH) have been demonstrated. LH offers less postoperative morbidity, less blood loss, and shorter hospital stay, while maintaining oncological safety. Only limited evidence about outcomes of LH in elderly is currently available. Therefore, this study aimed to compare short term outcomes of LH to OH for patients >65 years. Methods: A systematic review and meta-analysis were performed according to Cochrane guidelines. Embase, PubMed, Cochrane Library, and Google Scholar were searched to identify eligible studies. Studies were included if they compared LH to OH, and focused on an elderly population, or had a majority of patients >65 years. Perioperative and postoperative outcomes were analyzed. Results: Thirteen studies with 1174 patients (LH:532, OH:642) were included for analysis. When compared to OH, elderly undergoing LH had significantly less postoperative complications (risk ratio [RR] 0.52; 95% confidence interval (CI):0.43-0.63), less blood loss (mean difference [MD]-198.58; 95% CI:299.88 to -97.28), and shorter length of stay (MD-4.83; 95%CI:-7.91 to -1.84), while oncological safety was non-inferior (RR1.04; 95%CI:1.00-1.08). Conclusions: Within the elderly population LH seems to be superior to OH, concerning short-term outcomes. However, for broader applicability more trials are needed including more difficult and major resections.
AB - Background and aim: Favorable outcomes of laparoscopic hepatectomy (LH) over open hepatectomy (OH) have been demonstrated. LH offers less postoperative morbidity, less blood loss, and shorter hospital stay, while maintaining oncological safety. Only limited evidence about outcomes of LH in elderly is currently available. Therefore, this study aimed to compare short term outcomes of LH to OH for patients >65 years. Methods: A systematic review and meta-analysis were performed according to Cochrane guidelines. Embase, PubMed, Cochrane Library, and Google Scholar were searched to identify eligible studies. Studies were included if they compared LH to OH, and focused on an elderly population, or had a majority of patients >65 years. Perioperative and postoperative outcomes were analyzed. Results: Thirteen studies with 1174 patients (LH:532, OH:642) were included for analysis. When compared to OH, elderly undergoing LH had significantly less postoperative complications (risk ratio [RR] 0.52; 95% confidence interval (CI):0.43-0.63), less blood loss (mean difference [MD]-198.58; 95% CI:299.88 to -97.28), and shorter length of stay (MD-4.83; 95%CI:-7.91 to -1.84), while oncological safety was non-inferior (RR1.04; 95%CI:1.00-1.08). Conclusions: Within the elderly population LH seems to be superior to OH, concerning short-term outcomes. However, for broader applicability more trials are needed including more difficult and major resections.
KW - OPEN LIVER RESECTION
KW - HEPATOCELLULAR-CARCINOMA
KW - HEPATIC RESECTION
KW - METASTASES
KW - TUMORS
KW - MANAGEMENT
KW - COHORT
U2 - 10.1016/j.hpb.2021.01.016
DO - 10.1016/j.hpb.2021.01.016
M3 - (Systematic) Review article
C2 - 33632653
SN - 1365-182X
VL - 23
SP - 984
EP - 993
JO - HPB
JF - HPB
IS - 7
ER -