Minimally invasive laparoscopic surgery versus open surgery of hepatocellular carcinoma (HCC) in old age

Medical (General Surgery)

Background In recent decades, the use of laparoscopic liver resection (LLR) has grown significantly. Laparoscopic and open large liver resections for the treatment of hepatocellular carcinoma (HCC) have not been well studied, despite numerous authors' reports that LLR is safer and more effective than open liver resection (OLR). Objective To determine minimally invasive laparoscopic surgery versus open surgery of hepatocellular carcinoma (HCC) in old age. Methods A cross-sectional study was conducted at Pakistan Liver and Kidney Institute, Lahore, Pakistan, which was performed between April 2023 to March 2024. The total number of patients in our study were 100. The number of female patients in our study were 35 and males were 65. For all patients, we did diagnostic tests before surgery blood test, Ultrasound and biopsy. Our main focus was on open surgery versus minimally invasive laparoscopic surgery for hepatocellular carcinoma (HCC) in old age patients. We excluded pregnant women in our study. Data was tabulated and analyzed by SPSS version 27 and MATLAB. Result In a current study total 100 patients were enrolled. Patients who underwent Minimally Invasive Surgery (MIS) experienced significantly shorter hospital stays, averaging 2.4 days compared to 6.3 days for those undergoing Open Surgery, as well as faster recovery times of 2.9 weeks versus 7.3 weeks. The MIS group demonstrated a lower complication rate of 21% compared to 39% in the Open Surgery group. The mean Body Mass Index (BMI) was comparable between the two groups, with Open Surgery patients averaging 34.2 and MIS patients 34.5 (p = 0.500), indicating similar baseline obesity levels. The difference in hospital length of stay was statistically significant, with the MIS group staying an average of 3.9 days less than the Open Surgery group (p < 0.001). Additionally, recovery time also showed significant differences, with MIS patients recovering 4.4 weeks faster than their Open Surgery counterparts (p < 0.001). Although the Open Surgery group had a higher overall complication rate of 65% compared to 52.5% in the MIS group, this difference did not achieve statistical significance with the current sample size (p = 0.0211). The study groups were well-matched in terms of age (p = 0.615) and Body Mass Index (BMI) (p = 0.500). However, there was a statistically significant difference in gender distribution (p = 0.034), with a higher proportion of males in the Minimally Invasive Surgery (MIS) group (75%) compared to the Open Surgery group (58%). Although the mean tumor size was slightly larger in the MIS group (3.0 cm) compared to the Open Surgery group (2.8 cm), this difference was not statistically significant (p = 0.188). In our study P-Value were less than (< 0.05). Conclusion Our study found that individuals who have minimally invasive hepatocellular carcinoma (HCC) surgery recover more quickly than those who undergo open surgery. Compared to open surgery, individuals who undergo minimally invasive procedures spend less time in the hospital. Compared to the left lobe of the liver, HCC is more frequent in the right lobe. For patients undergoing liver resection, minimally invasive surgery is less likely to result in surgical wound and organ infections than open surgery. The majority of patients with hepatocellular carcinoma (HCC) were elderly.

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