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Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients : a multicenter propensity score based analysis of short- and long-term outcomes

(2017) ANNALS OF SURGERY. 265(6). p.1192-1200
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Abstract
Objective: This study aims to compare the perioperative and oncological outcomes of laparoscopic and open liver resection for colorectal liver metastases in the elderly. Background: Laparoscopic liver resection has been associated with less morbidity and similar oncological outcomes to open liver resection for colorectal liver metastases (CRLMs). It has been reported that these benefits continue to be observed in elderly patients. However, in previous studies, patients over 70 or 75 years were considered as a single, homogenous population raising questions regarding the true impact of the laparoscopic approach on this diverse group of elderly patients. Method: Prospectively maintained databases of all patients undergoing liver resection for CRLM in 5 tertiary liver centers were included. Those over 70years old were selected for this study. The cohort was divided in 3 subgroups based on age. A comparative analysis was performed after the implementation of propensity score matching on the 2 main cohorts (laparoscopic and open groups) and also on the study subgroups. Results: A total of 775 patients were included in the study. After propensity score matching 225 patients were comparable in each of the main groups. Lower blood loss (250 vs 400 mL, P = 0.001), less overall morbidity (22% vs 39%, P = 0.001), shorter High Dependency Unit (2 vs. 6 days, P = 0.001), and total hospital stay (5 vs. 8 days, P = 0.001) were observed after laparoscopic liver resection. Comparable rates of R0 resection (88% vs 88%, P = 0.999), median recurrence-free survival (33 vs 27 months, P = 0.502), and overall survival (51 vs 45months, P = 0.671) were observed. The advantages seen with the laparoscopic approach were reproduced in the 70 to 74-year old subgroup; however there was a gradual loss of these advantages with increasing age. Conclusions: In patients over 70 years of age laparoscopic liver resection, for colorectal liver metastases, offers significant lower morbidity, and a shorter hospital stay with comparable oncological outcomes when compared with open liver resection. However, the benefits of the laparoscopic approach appear to fade with increasing age, with no statistically significant benefits in octogenarians except for a lower High Dependency Unit stay.
Keywords
colorectal liver metastases, elderly patients, laparoscopic liver resection, octogenarians, oncological outcomes, propensity score, short-term outcomes, SINGLE-CENTER EXPERIENCE, HEPATOCELLULAR-CARCINOMA, ONCOLOGICAL OUTCOMES, HEPATECTOMY, CANCER, SURGERY, AGE, EFFICIENCY, SURVIVAL

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Chicago
Martínez-Cecilia, David, Federica Cipriani, Shelat Vishal, Francesca Ratti, Hadrien Tranchart, Leonid Barkhatov, Federico Tomassini, et al. 2017. “Laparoscopic Versus Open Liver Resection for Colorectal Metastases in Elderly and Octogenarian Patients : a Multicenter Propensity Score Based Analysis of Short- and Long-term Outcomes.” Annals of Surgery 265 (6): 1192–1200.
APA
Martínez-Cecilia, D., Cipriani, F., Vishal, S., Ratti, F., Tranchart, H., Barkhatov, L., Tomassini, F., et al. (2017). Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients : a multicenter propensity score based analysis of short- and long-term outcomes. ANNALS OF SURGERY, 265(6), 1192–1200.
Vancouver
1.
Martínez-Cecilia D, Cipriani F, Vishal S, Ratti F, Tranchart H, Barkhatov L, et al. Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients : a multicenter propensity score based analysis of short- and long-term outcomes. ANNALS OF SURGERY. 2017;265(6):1192–200.
MLA
Martínez-Cecilia, David, Federica Cipriani, Shelat Vishal, et al. “Laparoscopic Versus Open Liver Resection for Colorectal Metastases in Elderly and Octogenarian Patients : a Multicenter Propensity Score Based Analysis of Short- and Long-term Outcomes.” ANNALS OF SURGERY 265.6 (2017): 1192–1200. Print.
@article{8523764,
  abstract     = {Objective: This study aims to compare the perioperative and oncological outcomes of laparoscopic and open liver resection for colorectal liver metastases in the elderly. 
Background: Laparoscopic liver resection has been associated with less morbidity and similar oncological outcomes to open liver resection for colorectal liver metastases (CRLMs). It has been reported that these benefits continue to be observed in elderly patients. However, in previous studies, patients over 70 or 75 years were considered as a single, homogenous population raising questions regarding the true impact of the laparoscopic approach on this diverse group of elderly patients. 
Method: Prospectively maintained databases of all patients undergoing liver resection for CRLM in 5 tertiary liver centers were included. Those over 70years old were selected for this study. The cohort was divided in 3 subgroups based on age. A comparative analysis was performed after the implementation of propensity score matching on the 2 main cohorts (laparoscopic and open groups) and also on the study subgroups. 
Results: A total of 775 patients were included in the study. After propensity score matching 225 patients were comparable in each of the main groups. Lower blood loss (250 vs 400 mL, P = 0.001), less overall morbidity (22\% vs 39\%, P = 0.001), shorter High Dependency Unit (2 vs. 6 days, P = 0.001), and total hospital stay (5 vs. 8 days, P = 0.001) were observed after laparoscopic liver resection. Comparable rates of R0 resection (88\% vs 88\%, P = 0.999), median recurrence-free survival (33 vs 27 months, P = 0.502), and overall survival (51 vs 45months, P = 0.671) were observed. The advantages seen with the laparoscopic approach were reproduced in the 70 to 74-year old subgroup; however there was a gradual loss of these advantages with increasing age. 
Conclusions: In patients over 70 years of age laparoscopic liver resection, for colorectal liver metastases, offers significant lower morbidity, and a shorter hospital stay with comparable oncological outcomes when compared with open liver resection. However, the benefits of the laparoscopic approach appear to fade with increasing age, with no statistically significant benefits in octogenarians except for a lower High Dependency Unit stay.},
  author       = {Mart{\'i}nez-Cecilia, David and Cipriani, Federica and Vishal, Shelat and Ratti, Francesca and Tranchart, Hadrien and Barkhatov, Leonid and Tomassini, Federico and Montalti, Roberto and Halls, Mark and Troisi, Roberto and Dagher, Ibrahim and Aldrighetti, Luca and Edwin, Bjorn and Abu Hilal, Mohammad},
  issn         = {0003-4932},
  journal      = {ANNALS OF SURGERY},
  language     = {eng},
  number       = {6},
  pages        = {1192--1200},
  title        = {Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients : a multicenter propensity score based analysis of short- and long-term outcomes},
  url          = {http://dx.doi.org/10.1097/sla.0000000000002147},
  volume       = {265},
  year         = {2017},
}

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