Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):1-7. 10.14701/ahbps.2021.25.1.1.

Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: A propensity case-matched analysis of the long-term survival

• Ho KM
• Cheng KC
• Chan FKM
• Yeung YP

• KMID: 2513169
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.1

Abstract

Backgrounds/Aims
Despite the widespread popularity of laparoscopic surgery, laparoscopic liver resection (LLR) remains in evolution. This study aimed to compare the long-term outcomes for patients undergoing laparoscopic versus open hepatectomy for hepatocellular carcinoma (HCC) ≤7 cm.
Methods
Patients diagnosed with HCC treated by hepatectomy from October 2000 to May 2019 were included. Excluding tumors larger than 7 cm, 1:2 propensity score matching was performed between laparoscopic and open hepatectomies. The perioperative outcomes, 5-year overall survival (OS) and disease-free survival (DFS) of the two groups were compared.
Results
Forty-five patients who underwent LLR were matched to 90 open hepatectomy (OH) during the same period. LLR group had shorter median hospital stay (5 days vs. 9 days, p=0.00) but required longer operative time (326.0 minutes vs. 272.5 minutes, p=0.018) than the OH group. The 5-year overall survival was better in the LLR group (84.9% vs. 61.1%; p=0.036), though there was no significant difference in the 5-year disease free survival (20.0% vs. 22.2%, p=0.613). The rate of R0 resection was comparable between the 2 groups with a slightly better margin distance in the LLR (5 mm vs. 3 mm, p=0.043).
Conclusions
Laparoscopic liver resection is safe and feasible for cirrhotic patients with HCC size up to 7 cm. It has better short-term outcomes and comparable perioperative blood loss and complication rates. The resection margin is not jeopardized and the 5-year overall and disease-free survivals are comparable with the open group.

Keyword

Hepatocellular carcinoma; Laparoscopic hepatectomy; Survival; Long-term outcome

Figure

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  Fig. 1 Kaplan-Meier curve showing disease-free survival of hepatocellular carcinoma patients underwent laparoscopic versus open liver resection.

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  Fig. 2 Kaplan-Meier curve showing overall survival of hepatocellular carcinoma patients underwent laparoscopic versus open liver resection.

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