Minimally invasive ver-sus open liver resection for hepatocellular carcinoma in the elderly: international multicentre propensity score-matched study

Hepatocellular carcinoma (HCC) is a disease with a high burden mainly affecting elderly patients. Most patients have underlying liver cirrhosis1,2. Elderly patients are increasingly seeking treatment for HCC in parallel with rising incidence and general life expectancy2–4. Resection is considered the most suitable curative option in elderly patients. Improvements in perioperative care and surgical techniques have mitigated the risks of resection, thereby expanding the pool of patients considered for resection1,5. One such improvement has been the adoption of minimally invasive liver surgery (MILS)6. For HCC, MILS has been associated with a shorter hospital stay, less blood loss, fewer transfusions, as well as lower mortality, and overall and liver-specific morbidity rates7–10. Concerns have been expressed, however, regarding its safety in elderly patients. The specific physiological stress endured during minimally invasive surgery might increase the morbidity and mortality risk in patients with limited reserve, but this hypothesis has not yet been supported by strong evidence11,12.