Review finds fewer complications with minimally invasive liver surgery in selected older adults
A review of retrospective studies found no statistically significant difference in short-term death or long-term survival compared with open surgery.
High evidenceReviewInterpret with caution
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
Researchers searched four medical databases for studies available through November 20, 2025, and compared minimally invasive liver resection with open liver resection in older adults with hepatocellular carcinoma. The analysis included 1,367 people who had minimally invasive surgery and 1,725 who had open surgery.
The minimally invasive approach was associated with fewer overall complications and fewer major complications. The review also reported fewer pulmonary complications, less blood loss, and shorter hospital stays. Differences in 90-day mortality, disease-free survival, and overall survival were not statistically significant, but this does not establish that the two approaches have equivalent outcomes.
What the review examined
The researchers examined whether minimally invasive liver resection was associated with different outcomes from open liver resection in adults aged 65 or older undergoing curative-intent surgery for hepatocellular carcinoma. They conducted a systematic review and meta-analysis following PRISMA reporting guidance, registered the review prospectively, and included 14 retrospective human studies with 3,092 participants. Where survival information was not directly reported, the researchers extracted or reconstructed time-to-event data from published results, including Kaplan-Meier graphs.
What the evidence shows
Compared with open surgery, minimally invasive surgery was associated with lower odds of overall complications: odds ratio 0.47, with a 95% confidence interval of 0.38 to 0.58. It was also associated with lower odds of major complications: odds ratio 0.61, with a 95% confidence interval of 0.45 to 0.83. The review reported fewer pulmonary complications, lower estimated blood loss, and shorter hospital stays with minimally invasive surgery. There was no statistically significant difference in 90-day mortality, with an odds ratio of 0.75 and a 95% confidence interval of 0.41 to 1.38. Differences in disease-free survival and overall survival were also not statistically significant. The researchers emphasized that these findings are associations in selected patients, not evidence that minimally invasive surgery itself caused better outcomes.
Who this may apply to
The findings may be relevant to older adults aged 65 or above with hepatocellular carcinoma who are considered suitable for curative-intent liver resection and resemble the selected patients in the included studies. Applicability is uncertain for octogenarians, people with substantial frailty or limited physical reserve, patients with larger or less favorably located tumors, and those needing extensive resections. The review does not establish outcomes for people who are not candidates for surgery or for non-surgical treatments.
Why it matters
Older adults with resectable hepatocellular carcinoma were the focus of this review, a group for whom recovery from surgery may be an important concern. The findings suggest that, among selected older adults who received these operations, minimally invasive surgery was linked with fewer short-term complications. They do not establish that it is superior to open surgery, do not confirm equal long-term cancer outcomes, and may not apply to people with more advanced age, greater frailty, more difficult tumors, or more extensive planned resections.
Limitations & evidence assessment
All 14 included studies were retrospective, so differences between the patients selected for minimally invasive and open surgery could explain some or all of the observed associations. The review noted that minimally invasive surgery was more often used for patients with smaller tumors, more favorable tumor locations, less extensive resections, and adequate physical reserve. Most operations were minor resections, validated frailty assessments were not available, and data on adults in their 80s were limited. The survival results had substantial variation between studies, and some survival estimates were reconstructed from Kaplan-Meier graphs rather than taken directly from reports. The absence of a statistically significant survival difference should not be interpreted as proof that the approaches are equivalent.
Why this evidence level: Meta-analysis pooling multiple studies sits at the top of common evidence hierarchies.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
Annals of Hepato-Biliary-Pancreatic Surgery · 2026 · DOI: 10.14701/ahbps.26-167
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