Laparoscopic liver resection: evolution of a single Surgeon's experience in MILS with 129 cases

Abstract

Background: Laparoscopic liver resection (LLR) has been reported as safe and effective approach to the management of hepatocarcinoma (HCC). However, in decompensated cirrhosis, studies of long-term outcome about tumor recurrence and patient survival in comparison with other standard treatments are limited. The aim of this study is to analyze the long term outcome of LLR versus transarterial chemoembolization (TACE) for treatment of HCC in Child B patients. Methods: Patients treated with LLR at a single European center were compared with patients treated with TACE included in the ITA.LI.CA database (a national multicenter HCC database). Only patients with same characteristics and adequate follow up were extracted from the database. A propensity score analysis was made matching patients by: age, sex, etiology of liver disease, number of lesions and size of largest nodule. Results: Since 2004 to 2016, 35 patients underwent LLR. Those treated with TACE, identified in the database, were 200. Median overall survival (OS) was not statistically different between groups. After propensity score analysis LLR provided significantly better 3(p=0,05), 5(p=0,04) year survival and OS (p=0,03) than TACE: 44,9months (95% CI:14,9-74,9) versus 18,2 (95% CI:8,4-30,1) respectively. Conclusion: LLR provides significantly better long-term survival than TACE in superselected patients with Child B cirrhosis. Thus, due to its low invasiveness, LLR should be part of multimodal management of HCC even in presence of mild liver function impairment.