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Wong et al. Hepatoma Res 2021;7:45 https://dx.doi.org/10.20517/2394-5079.2021.28 Page 5 of 11

Table 1. Patients’ baseline characteristics
Open resection (n = 92) Laparoscopic resection (n = 46) P
Age, years 71 (65-83) 70 (65-85) 0.660
Male: female 62:30 31:15 1.000
Body mass index 23.5 (14-35) 24.2 (17-31) 0.096
Hepatitis B virus carrier 68 (73.9%) 32 (69.6%) 0.590
Hepatitis C virus carrier 6 (8.6%) 3 (6.5 %) 1.000
Child A disease 91 (98.9%) 45 (97.8%) 1.000
Ascites 0.333
Absent 92 (100%) 45 (97.8%)
Slight 0 (0%) 1 (2.2%)
Hemoglobin, g/dL 13.5 (9.3-16.9) 13.35 (6.6-15.1) 0.481
Total bilirubin, μmol/L 11 (4-70) 10 (3-26) 0.504
Aspartate transaminase, IU/L 37 (16-125) 37 (13-133) 0.586
Alanine transaminase, IU/L 30.5 (7-412) 33 (17-216) 0.659
Creatinine, μmol/L 80 (41-140) 81 (48-948) 0.610
Albumin, g/L 42 (31-54) 43 (32-52) 0.453
Alpha-fetoprotein, ng/mL 8 (1-13209) 18 (2-517) 0.741
≤ 400 ng/mL 81 (88%) 44 (95.7%) 0.219
> 400 ng/mL 11 (12%) 2 (4.3%)
International normalized ratio (admission) 1.05 (0.8-1.3) 1.1 (0.9-1.2) 0.592
9
Platelet count × 10 /L 164 (68-395) 145.5 (47-277) 0.127
Indocyanine green retention rate at 15 min 11.5 (3.7-36.3) 10.9 (4.2-42.5) 0.052
Comorbidity 68 (73.9%) 38 (82.6%) 0.254
Cardiovascular 63 (68.5%) 35 (76.1%) 0.353
Pulmonary 8 (8.7%) 2 (4.3%) 0.496
Renal 3 (3.3%) 1 (2.2%) 1.000
Diabetes mellitus 33 (35.9%) 21 (45.7%) 0.267

disease-free survival rates were 87%, 69.9%, and 59.9% in the laparoscopic group, respectively, and 76.5%,
53.6%, and 43.3% in the open group, respectively (P = 0.029). Thirty-four patients (73.9%) in the
laparoscopic group and 42 patients (45.7%) in the open group remained disease free during the follow-up
period (P = 0.002).

DISCUSSION
This retrospective propensity-score matched analysis demonstrated that laparoscopic hepatectomy is not
only safe and feasible to elderly HCC patients, but it is associated with improved disease-free survival of
about 20 months when compared to the conventional open hepatectomy group.

With increasing life expectancy, it is expected that increasing number of liver resection will be performed
for elderly patients with HCC. The open approach has been shown to be a feasible option with acceptable
morbidity rates and satisfactory oncological outcome in elderly patients with HCC [8,9,16] . In the era of
minimally invasive surgery, laparoscopic hepatectomies in elderly patients with malignant liver tumours has
demonstrated similar short-term benefits as seen in younger patients [4,10,12,17] . The role of laparoscopic
approach in the management of HCC in elderly patients remains uncertain. Limited data in terms of
oncological outcome and long-term survival has been reported in this population [18-21] .