Objective To investigate the clinical efficacy of laparoscopic hepatectomy for elderly patients with solitary hepatocellular carcinoma.

Methods The propensity score matching (PSM) and retrospective cohort study was conducted. The clinicopathological data of 583 patients who underwent laparoscopic hepatectomy for solitary hepatocellular carcinoma at The First Affiliated Hospital (Southwest Hospital) of Army Medical University from January 2015 to December 2021 were collected. There were 507 males and 76 females, aged 49(44,57) years. Among the 583 patients, 475 cases aged ≤60 years were classified into non‑elderly group and 108 cases aged ≥70 years were classified into elderly group. Observation indicators: (1) PSM and comparison of clinico-pathological characteristic of patients between the two groups after matching; (2) perioperative situations of patients; (3) survival analysis; (4) prognostic factor analysis of patients. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the non‑parameter rank sum test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the non‑parameter rank sum test. The Kaplan‑Meier method was used to calculate survival rates and plot survival curves, and Log‑rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazards regression model. Variables with P<0.1 in univariate analysis were entered into the multivariate analysis. PSM was performed using the 1∶1 optimal full matching method with a caliper value of 0.1.

Results (1) PSM and comparison of clinicopathological characteristic of patients between the two groups after matching: of the 583 patients, 186 cases were successfully matched, with 93 cases in the non‑elderly group and 93 cases in the elderly group. After PSM, the elimination of gender, indocyanine green retention rate at 15 minutes, and tumor differentiation grade confounding bias ensured comparability. (2) Peri⁃operative situations of patients: after PSM, the operation time, volume of intraoperative blood loss, cases with intraoperative transfusion, duration of postoperative hospital stay, cases with postoperative complications were 187(145,230) minutes, 200(150,300) mL, 8, 9(7,11) days, 9 for the non-elderly group, versus 197(147,245) minutes, 200(100, 300) mL, 8, 8(7,11) days, 7 for the elderly group, respectively, showing no significant difference between the two groups (Z=-0.81, 0.62, χ²=0.00, Z=0.05, χ²=0.27, P>0.05). According to the Clavien‑Dindo classification, Grade Ⅰ and Grade Ⅱ complications occurred in 5 and 4 cases in the non‑elderly group, versus 6 and 1 case in the elderly group, with no significant difference between groups (χ²=1.91, P>0.05). (3) Survival analysis: after PSM, patients in the non‑elderly group and in the elderly group were followed up for 73(66,88) months and 65(57,70) months. The 1‑, 3‑, and 5‑year overall survival rates in the non‑elderly group were 92.4%, 77.8%, 65.8%, respectively, versus 90.2%, 75.6%, and 64.4% in the elderly group, with no significant difference between them (χ²=0.10, P>0.05). The 1‑, 3‑, and 5-year recurrence‑free survival rates in the elderly group were 80.5%, 68.5%, and 59.9%, respectively, versus 78.2%, 57.9%, and 41.0% in the non‑elderly group, with a significant difference between them (χ²=5.08, P<0.05). (4) Prognostic factor analysis of patients: multivariate analysis showed that alpha‑fetoprotein as 20 or above and less than 400 μg/L, tumor diameter ≥5.0 cm, tumor involvement of 3 hepatic segments, and tumor involvement of 4 hepatic segments were independent risk factors for overall survival rate of patients with solitary hepatocellular carcinoma (hazard ratio=1.39, 1.52, 1.78, 2.66, 95% confidence interval as 1.01-1.91, 1.14-2.03, 1.03-3.06, 1.21-5.82, P<0.05). Age ≥70 years was an independent protective factor for recurrence‑free survival rate of patients with solitary hepatocellular carcinoma (hazard ratio=0.59, 95% confidence interval as 0.39-0.76, P<0.05). Tumor diameter ≥5.0 cm and tumor involvement of 4 hepatic segments were independent risk factors for recurrence‑free survival rate of patients with solitary hepatocellular carcinoma (hazard ratio=1.41, 2.56, 95% confidence interval as 1.12-1.78, 1.30-5.05, P<0.05).

Conclusion Laparoscopic liver resection achieves comparable long‑term overall survival but superior recurrence‑free survival in well-selected elderly patients with solitary hepatocellular carcinoma compared to non‑elderly patients.