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

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.