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Wong et al. Hepatoma Res 2021;7:45 https://dx.doi.org/10.20517/2394-5079.2021.28 Page 9 of 11

venous thrombus, need of bile duct reconstruction, and need of associating liver partition with portal vein
ligation for staged hepatectomy (ALPPS) are no longer exclusive to open hepatectomy.

Improving perioperative care with multidisciplinary support from anesthetist, physiotherapist and nursing
staff over the 10-year period of the study has allowed more elderly patients to be recruited for major
operations. Early recovery was made possible with emphasis on early feeding, early mobilization, and pain
control. Towards the end of the study (2018), our center has performed 12 laparoscopic hepatectomies on
elderly patients compared with only 2 in 2008. The duration of hospitalization was similar to young
counterparts for both laparoscopic and open group compared with previously published data in our
center . With continuous refinement and standardization of perioperative management, further
[6,7]
improvement in patients’ outcomes could be expected in future studies.

Due to the retrospective and non-randomized nature of the study design, it is bound to have various
limitation and biases. To overcome the inherent risk of selection bias in the study population, propensity
score matching was performed in an attempt to reduce the differences in covariate distribution in each
group.

In conclusion, our findings suggest that laparoscopic liver resection is a safe and feasible approach for
elderly HCC patients with significant benefits in short-term outcomes. It was also associated with a better
oncological outcome in terms of survival. Nonetheless, further multicentred prospective studies with a
larger cohort are warranted to evaluate superiority of laparoscopic hepatectomy in elderly patients.

DECLARATIONS
Authors’ contributions
Conception and design of the study, critical revise of article: Ma KW, Cheung TT
Performed data analysis and interpretation, drafting the article: Wong PWY, Ma KW
Read and approved the final version of the manuscript: She WH, Dai WC, Chan ACY, Chok KSH, Lo CM

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
©The Author(s) 2021.