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Peer-reviewedCC BYAnnals of gastroenterological surgery

Impact of Laparoscopic Liver Resection on Long‐Term Outcomes and Non‐Liver‐Related Mortality in Elderly Patients With Primary Hepatocellular Carcinoma: A Multicenter Propensity Score‐Matched Analysis

  • Yukio Tokumitsu1,2
  • Hidenori Takahashi1,2
  • Yuki Nakagami2,3
  • Toru Hisaka1,4
  • Hiromitsu Hayashi1,5
  • Tomoharu Yoshizumi1,6
  • Norifumi Harimoto1,7
  • Takao Ide1,8
  • Yoichi Yamasaki1,9
  • Atsushi Miyoshi1,10
  • Yuichi Endo1,11
  • Tamotsu Kuroki1,12
8 more authors
  • Atsushi Nanashima1,13
  • Masahiko Sakoda1,14
  • Tohru Utsunomiya1,15
  • Kohji Okamoto1,16
  • Masatoshi Kajiwara1,17
  • Mitsuhisa Takatsuki1,18
  • Toru Beppu1,19
  • Susumu Eguchi1,20
20 affiliations
  1. 1Kyushu Study Group of Liver Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
  2. 2Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Ube Japan
  3. 3Health Data Science Lab, Faculty of Data Science Shimonoseki City University Shimonoseki Japan
  4. 4Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery Kurume University Kurume Japan
  5. 5Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University Kumamoto Japan
  6. 6Department of Surgery and Science, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
  7. 7Department of Hepato‐Biliary‐Pancreatic Surgery, Clinical Research Institute National Hospital Organization Kyushu Medical Center Fukuoka Japan
  8. 8Department of Surgery Saga University Faculty of Medicine Saga Japan
  9. 9Department of Digestive Surgery Kagoshima University Graduate School of Medical and Dental Sciences Kagoshima Japan
  10. 10Department of Surgery Saga‐Ken Medical Centre Koseikan Saga Japan
  11. 11Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Graduate School of Medicine Yufu Japan
  12. 12Clinical Research Center and Department of Surgery National Hospital Organization Nagasaki Medical Center Ōmura Japan
  13. 13Division of Hepato‐Biliary‐Pancreas Surgery, Department of Surgery University of Miyazaki Faculty of Medicine Miyazaki Japan
  14. 14Department of Surgery Kagoshima Kouseiren Hospital Kagoshima Japan
  15. 15Department of Surgery Oita Prefectural Hospital Oita Japan
  16. 16Department of Surgery, Gastroenterology and Hepatology Center Kitakyushu City Yahata Hospital Kitakyushu Japan
  17. 17Department of Gastroenterological Surgery, Faculty of Medicine Fukuoka University Fukuoka Japan
  18. 18Department of Digestive and General Surgery, Graduate School of Medicine University of the Ryukyus Ginowan Japan
  19. 19Department of Surgery Yamaga City Medical Center Yamaga Japan
  20. 20Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
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Abstract

Background: Elderly patients with hepatocellular carcinoma (HCC) are increasingly undergoing hepatectomy. Although laparoscopic liver resection (LLR) has been shown to provide better short‐term outcomes than open liver resection (OLR), long‐term outcomes are generally considered comparable. However, the impact of surgical approach on cause‐specific death, particularly non‐liver‐related death, remains unclear in elderly patients.

Methods: This multicenter retrospective study included 969 patients ≥ 65 years old who underwent curative hepatectomy for solitary primary HCC ≤ 5 cm in maximum diameter at 18 institutions between 2010 and 2018. Propensity score matching was performed to reduce selection bias. Short‐ and long‐term outcomes, including liver‐related and non‐liver‐related death, were compared between LLR and OLR. Subgroup analyses were conducted according to age group.

Results: After matching, LLR was significantly associated with lower blood loss, fewer postoperative complications, and shorter hospital stay than OLR. In the entire cohort, overall survival did not differ between groups. Among non‐liver‐related deaths, respiratory disease‐related death was more frequent in the OLR group. Among patients ≥ 80 years old, the incidence of non‐liver‐related death excluding death from other cancers was significantly lower in the LLR group, even after propensity score matching.

Conclusions: LLR may reduce the risk of non‐liver‐related death excluding death from other cancers in patients ≥ 80 years old with solitary HCC ≤ 5 cm in maximum diameter. When determining surgical strategies in elderly patients, it is important to consider long‐term systemic outcomes in addition to oncological factors. In patients for whom LLR is technically feasible, its minimally invasive nature may provide clinical benefits.

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Cite

BibTeXRIS
BibTeX
@article{tokumitsu2026impact,
  title = {{Impact of Laparoscopic Liver Resection on Long‐Term Outcomes and Non‐Liver‐Related Mortality in Elderly Patients With Primary Hepatocellular Carcinoma: A Multicenter Propensity Score‐Matched Analysis}},
  author = {Yukio Tokumitsu and Hidenori Takahashi and Yuki Nakagami and Toru Hisaka and Hiromitsu Hayashi and Tomoharu Yoshizumi and Norifumi Harimoto and Takao Ide and Yoichi Yamasaki and Atsushi Miyoshi and Yuichi Endo and Tamotsu Kuroki and Atsushi Nanashima and Masahiko Sakoda and Tohru Utsunomiya and Kohji Okamoto and Masatoshi Kajiwara and Mitsuhisa Takatsuki and Toru Beppu and Susumu Eguchi},
  journal = {Annals of gastroenterological surgery},
  year = {2026},
  month = nov,
  doi = {10.1002/ags3.70306},
  url = {https://europepmc.org/article/PMC/PMC13727762},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Impact of Laparoscopic Liver Resection on Long‐Term Outcomes and Non‐Liver‐Related Mortality in Elderly Patients With Primary Hepatocellular Carcinoma: A Multicenter Propensity Score‐Matched Analysis
AU  - Yukio Tokumitsu
AU  - Hidenori Takahashi
AU  - Yuki Nakagami
AU  - Toru Hisaka
AU  - Hiromitsu Hayashi
AU  - Tomoharu Yoshizumi
AU  - Norifumi Harimoto
AU  - Takao Ide
AU  - Yoichi Yamasaki
AU  - Atsushi Miyoshi
AU  - Yuichi Endo
AU  - Tamotsu Kuroki
AU  - Atsushi Nanashima
AU  - Masahiko Sakoda
AU  - Tohru Utsunomiya
AU  - Kohji Okamoto
AU  - Masatoshi Kajiwara
AU  - Mitsuhisa Takatsuki
AU  - Toru Beppu
AU  - Susumu Eguchi
PY  - 2026
DA  - 2026/11/02
JO  - Annals of gastroenterological surgery
DO  - 10.1002/ags3.70306
UR  - https://europepmc.org/article/PMC/PMC13727762
AB  - Background: Elderly patients with hepatocellular carcinoma (HCC) are increasingly undergoing hepatectomy. Although laparoscopic liver resection (LLR) has been shown to provide better short‐term outcomes than open liver resection (OLR), long‐term outcomes are generally considered comparable. However, the impact of surgical approach on cause‐specific death, particularly non‐liver‐related death, remains unclear in elderly patients.  Methods: This multicenter retrospective study included 969 patients ≥ 65 years old who underwent curative hepatectomy for solitary primary HCC ≤ 5 cm in maximum diameter at 18 institutions between 2010 and 2018. Propensity score matching was performed to reduce selection bias. Short‐ and long‐term outcomes, including liver‐related and non‐liver‐related death, were compared between LLR and OLR. Subgroup analyses were conducted according to age group.  Results: After matching, LLR was significantly associated with lower blood loss, fewer postoperative complications, and shorter hospital stay than OLR. In the entire cohort, overall survival did not differ between groups. Among non‐liver‐related deaths, respiratory disease‐related death was more frequent in the OLR group. Among patients ≥ 80 years old, the incidence of non‐liver‐related death excluding death from other cancers was significantly lower in the LLR group, even after propensity score matching.  Conclusions: LLR may reduce the risk of non‐liver‐related death excluding death from other cancers in patients ≥ 80 years old with solitary HCC ≤ 5 cm in maximum diameter. When determining surgical strategies in elderly patients, it is important to consider long‐term systemic outcomes in addition to oncological factors. In patients for whom LLR is technically feasible, its minimally invasive nature may provide clinical benefits.
SN  - 2475-0328
ER  -