Safety of advanced laparoscopic hepatectomy for elderly patients: a Japanese nationwide analysis

Jiro Kusakabe; Kojiro Taura; Masayuki Nakashima; Masato Takeuchi; Etsuro Hatano; Koji Kawakami

doi:10.1007/s00464-024-10818-7

Safety of advanced laparoscopic hepatectomy for elderly patients: a Japanese nationwide analysis

Surg Endosc. 2024 Apr 17. doi: 10.1007/s00464-024-10818-7. Online ahead of print.

Authors

Jiro Kusakabe^{1

2}, Kojiro Taura¹, Masayuki Nakashima², Masato Takeuchi², Etsuro Hatano¹, Koji Kawakami³

Affiliations

¹ Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
² Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan.
³ Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Yoshida, Sakyo-ku, Kyoto, 606-8501, Japan. kawakami.koji.4e@kyoto-u.ac.jp.

PMID: 38630181
DOI: 10.1007/s00464-024-10818-7

Abstract

Background: Although basic laparoscopic hepatectomy (LH) has become the standard procedure for hepatectomy, the safety of advanced LH remains to be clarified, especially in elderly patients. We investigated the safety of advanced LH in elderly Japanese patients.

Methods: Elderly patients (≥ 65 years) who underwent advanced LH between 2016 and 2021 were analyzed using a nationwide claims database in Japan. The perioperative outcomes of patients who underwent open hepatectomy (OH group) or LH (LH group) were compared using propensity score matching (PSM). The primary outcome was in-hospital mortality. The E-value method was performed to assess the strength of the outcome point estimates against possible unmeasured confounding factors.

Results: Among 5,021 patients, eligible patients were classified into the OH (n = 4,152) and LH (n = 527) groups. The median patient age was 74 years in both groups. Hepatocellular carcinoma and metastatic liver tumors were the major indications for hepatectomy (OH: 52.5% versus 30.6%; LH: 60.7% versus 26.4%). After PSM, in-hospital mortality rates for OH and LH were 1.7 and 0.76%, respectively. The risk ratio was 0.45 (95% confidence interval, 0.16-1.25; E-value = 3.87). Compared with OH, LH was associated with a longer anesthesia time (411 versus 432 min), lower rate of blood product use (red blood concentrate: 33.5% versus 20.3%; fresh frozen plasma: 29.2% versus 17.1%), and shorter hospital stay (13 versus 12 days).

Conclusions: In elderly patients, the safety of advanced LH was similar to that of advanced OH, or might be better in Japan under the current policy of hospital accreditation.

Keywords: Advanced; Elderly; Hepatectomy; Laparoscopy; Liver resection; Safety.