Laparoscopic Resection for Liver Malignancies: Do the Elderly Benefit More?

Abstract

We read with great interest the study presented by Badawy and colleagues in the current issue of Journal of Investigative Surgery.1 The dogma that laparoscopic surgery is not suitable for the frail and elderly has been present since the early days of laparoscopy. This study is therefore of important. The authors present 40 patients operated with laparoscopic liver resection compared with 40 patients operated with open liver resection, analyzed with propensity scored matching. Operations took place between 2009 and 2016, in the Kyoto University Hospital. The authors report lower blood loss, shorter hospital stay, less complications and less recurrence in the laparoscopic group. As with all matched analyses, biases might have affected the results of this study. Most importantly, this study is not suited for oncologic analyses due to its design, low number of cases and relatively short follow-up. The interesting observation that laparoscopic liver resection for HCC carries a lower recurrence rate than open liver resection, might thus be a matter of either selection or coincidence. For instance, more patients in the open group had recurrent tumors, hepatitis C, and cirrhosis. In a large, propensity scored analysis from a European collaborative group, no such difference could be seen, this analysis was, however, based only on colorectal liver metastases.2 Nevertheless, there are theoretical mechanisms which may explain a possible oncologic benefit of laparoscopy. First and foremost, a reduced disturbance of the immunologic defense following laparoscopic