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

Table 3. Pathological characteristics
Open resection (n = 92) Laparoscopic resection (n = 46) P
Size of tumour, cm 4 (1-14) 3.3 (1.2-7) 0.003
Number of tumour nodule 0.106
1 78 (84.8%) 42 (91.3%)
2 7 (7.6%) 3 (6.5%)
3 2 (2.2%) 1 (2.2%)
Multiple 5 (5.4%) 0
Tumour pattern (solitary: multiple) 78:14 42:4 0.284
Site (unilobar:bilobar) 83:9 43:3 0.751
With macrovascular invasion 4 (4.3%) 0 0.301
With microvascular invasion 35 (38%) 18 (39.1%) 0.902
Nontumorous liver 0.801
Noncirrhotic 32 (34.8%) 17 (37%)
Cirrhotic 60 (65.2%) 29 (63%)
Resection margin 1.000
Not involved 91 (98.9%) 46 (100%)
Involved 1 (1.1%) 0
UICC7 0.163
Stage I 46 (50%) 25 (54.3%)
Stage II 32 (34.8%) 18 (39.1%)
Stage IIIA 4 (4.3%) 2 (4.3%)
Stage IIIB 4 (4.3%) 0
Stage IIIC 6 (6.5%) 1 (2.2%)
New Edmonson grading 0.72
Well-differentiated 14 (15.2%) 6 (13%)
Moderately differentiated 58 (63%) 33 (71.7%)
Poorly differentiated 18 (19.6%) 6 (13%)
Necrosis 0 (0%) 1 (2.2%)
Not available 1 (1.1%) 0 (0%)

laparoscopic device and high-definition laparoscopy with magnified view are key factors in the laparoscopic
approach that facilitates transection in a cirrhotic liver .
[10]

An important concern for use of laparoscopy in elderly patients is the creation of the CO
2
pneumoperitoneum, with the potential of impairing ventilation in patients with diminished reserve and/or
occult chronic lung diseases [22,29,30] . It is worthwhile to note that our study found a trend of fewer
cardiopulmonary complications in the laparoscopic group. The benefit of avoiding a subcostal, muscle
cutting incision likely outweigh its potential adverse effect of transient diaphragmatic splintage during the
intra-operative period.

Both the laparoscopic and the open group had similar cancer staging and Edmondson grading on final
pathological examination after propensity score matching. Although there is a statistically significant
differences in the tumour size between the groups, clinically, the median tumour size of the laparoscopic
and the open group differed only by 0.7 cm which was unlikely to cause significant impact to patient’s
selection and prognosis. The laparoscopic group showed better disease-free survival and a trend for better
overall survival, which is similar to findings in the younger patients. Less blood loss and fewer
intraoperative manipulation of tumour associated with laparoscopic resection may be attributable to a better