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Page 6 of 11 Wong et al. Hepatoma Res 2021;7:45 https://dx.doi.org/10.20517/2394-5079.2021.28

Table 2. Surgical characteristics and surgical outcomes
Open resection (n = 92) Laparoscopic resection (n = 46) P
Blood loss, L 0.5 (0.05-9) 0.1 (0.01-4) < 0.001
With blood transfusion 8 (8.7%) 5 (10.9%) 0.760
Blood replacement, L 0 (0-5.76) 0 (0-4.8) 0.692
Total operation time, min 274 (90-914) 196 (65-644) < 0.001
Magnitude of resection 1.000
Major 24 (26.1%) 12 (26.1%)
Minor 68 (73.9%) 34 (73.9%)
Type of resection 0.109
Right sided hepatectomy 14 (15.2%) 7 (15.2%)
Left sided hepactectomy 14 (15.2%) 16 (34.8%)
Central bisectionectomy 4 (4.3%) 1 (2.2%)
Anatomical segmentectomy 28 (30.4%) 9 (19.6%)
Wedge resection 32 (34.8%) 13 (28.3%)
Patients with complication 17 (18.5%) 5 (10.9%) 0.250
Number of complications 24 5 0.205
General 18 3
Surgical 6 2
General complications
Pulmonary complications 12 (12%) 1 (2.2%)
Cardiac arrhythmia 5 (5.4%) 1 (2.2%)
Ileus 0 1 (2.2%)
Urinary tract infection 1 (1.1%) 0
Surgical complications
Wound infection 2 (2.2%) 2 (4.3%)
Wound dehiscence 1 (1.1%) 0
Biliary leakage/fistula (grade B or above) 1 (1.1%) 0
Severe ascites requiring paracentesis 2 (2.2%) 0
With ICU admission 41 (44.6%) 13 (28.3%) 0.064
ICU admission, day 0 (0-18) 0 (0-5) 0.176
Hospital mortality 0 0
Hospital stay, day 8 (4-48) 5 (2-21) < 0.001

Historically, advanced age and presence of comorbid diseases have excluded patients from liver surgery.
Elderly patients represent a distinct population entity apart from younger patients. A diminished functional
reserve and the presence of comorbidities put elderly patients at risk of postoperative adverse cardiac events,
respiratory complications, and malnutrition. The risk of adverse cardiac events was further amplified by
longer operative time and perioperative blood transfusion [22-25] . Vigilant patient selection and preoperative
workup has allowed elderly patients with comorbidities to undergo laparoscopic surgery, such as colectomy
and gastrectomy, with acceptable rates of complications and good long-term outcome [26-28] .

To our knowledge, this study is the largest series on elderly patients with HCC in comparing laparoscopic
and open liver resection. All but 2 patients in this study had various degree of cirrhosis, in which increased
bleeding was anticipated. Yet the laparoscopic group has demonstrated better short-term outcomes in terms
of less blood loss volume, shorter operative time, and shorter hospital stay. Our study found no significant
differences in overall complications between the groups. Recent studies from other centres also
demonstrated satisfactory short-term outcomes with fewer complications in the laparoscopic
approach [10,18,19] . Apart from the creation of the pneumoperitoneum, advancement in haemostatic