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

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.

Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

“…Apart from two studies by Tsai et al [ 23 ] and Ho et al [ 35 ], all of the oncological outcomes at various time spans were not statistically different. For LLR, the reported ranges of 1-, 3- and 5-year overall survival and disease-free survival were 89.9%-100%, 68%-100% and 45.3%-94.5%, and 67%-93.8%, 36%-79.6% and 24%-67.4%, respectively.…”

“…When long-term oncological outcomes of the LLR and OLR group were assessed in terms of stage-specific overall survival and disease-free survival, the result did not differ significantly. On the other hand, in the study by Ho et al [ 35 ], the 5-year overall survival for LLR was better than OLR (84.9% vs 61.1%; P = 0.036), but disease-free survival was similar (20.0% vs 22.2%; P = 0.613). The survival advantage of LLR could be contributed by the five perioperative mortalities in the OLR group, which occurred all in the first half of the hepatectomy experience.…”

“…After 2018, 21 comparative studies of LLR vs OLR for HCC can be identified[ 15 - 35 ] (Tables 1 - 4 ). Only one was a randomized controlled trial[ 18 ], while the rest were non-randomized.…”

Pure laparoscopic liver resection versus percutaneous radiofrequency ablation for small hepatocellular carcinoma: a propensity score and multivariate analysis

“…With gaining evidence on its short-term benefits, which included shorter operative time (2,3), decreased blood loss (2,4), shorter hospital stay (2)(3)(4)(5)(6), and decreased overall morbidity (3)(4)(5)(6)(7), laparoscopic liver resection (LLR) had emerged as a valuable treatment option for selected patients (8). Recent publications had shown comparable oncological outcomes in terms of disease-free survival and overall survival for LLR and open liver resection (2)(3)(4)(5)(6)(7)9). Nevertheless, only 30% of patients with HCC were able to undergo liver resection.…”

Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence: A comparative study

“…Laparoscopic liver resection (LLR) has emerged as a valuable treatment option for HCC during the last decade. LLR has a shorter operative time, less blood loss, shorter hospital stay, and lower overall morbidity than open liver resection, along with comparable disease-free and overall survival (OS)[ 9 - 15 ]. However, because of the development of adhesions, altered anatomy, the establishment of collateral circulation, reduced liver function, and loss of liver parenchyma following the prior surgery, laparoscopic repeat hepatectomy (LRH) is technically more complex than primary resection.…”