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Long-Term Outcome of Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Case-Controlled Study with Propensity Score Matching

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Abstract

Background

Laparoscopic liver resection (LR) for hepatocellular carcinoma (HCC) is usually applied to superficial and left-side small lesions. Therefore, well designed comparative studies about the results of LR versus open liver resection (OR) for HCC are difficult and still uncommon. The aim of this study was to compare the perioperative and long-term oncologic outcomes of LR versus OR for HCC between well-matched patient groups.

Methods

Between January 2000 and March 2012, 205 patients (43 with intent-to-treat with LR, 162 OR) underwent primary liver resection of less than three segments for HCC in our center. To select a comparison group, propensity score matching (PSM) was used at 1:1 ratio with covariates of baseline characteristics, including tumor characteristics. Outcomes were compared between the matched groups.

Results

The two groups were well balanced by PSM and 29 patients were matched respectively. In LR, there was more non-anatomical resection (65.5 vs. 34.5 %; p = 0.012), less postoperative ascites (0.0 vs. 17.2 %; p = 0.025), and shorter hospital stay (7.69 ± 2.94 vs. 13.38 ± 7.37 days; p < 0.001). With the exception of these, there were no significant differences in perioperative and long-term outcomes. The 1-, 3- and 5-year survivals were 100, 100 and 92.2 % in LR, and 96.5, 92.2 and 87.7 % in OR (p = 0.267), respectively. The 1-, 3- and 5-year disease-free survivals were 81.7, 61.7 and 54.0 % in LR, and 78.6, 60.9 and 40.1 % in OR, respectively (p = 0.929).

Conclusions

The outcome of LR for HCC was technically feasible and safe in selected patients, and LR showed similar perioperative and long-term oncologic outcomes when compared with OR matched with PSM.

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Acknowledgments

For statistical treatment and analysis in the present study, we received complete assistance for PSM and substantial counsel for analysis of the outcomes of our study from the Medical Research Collaborating Center in the Seoul National University Hospital Biomedical Research Institute.

Disclosures

Drs. Hyeyoung Kim, Kyung-Suk Suh, Kwang-Woong Lee, Nam-Joon Yi, Geun Hong, Suk-Won Suh, Tae Yoo, Min-Su Park, YoungRok Choi, and Hae Won Lee have no conflicts of interest or financial ties to disclose.

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  1. Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea

    Hyeyoung Kim, Kyung-Suk Suh, Kwang-Woong Lee, Nam-Joon Yi, Geun Hong, Suk-Won Suh, Tae Yoo, Min-Su Park, YoungRok Choi & Hae Won Lee

  2. Department of Surgery, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, Republic of Korea

    Hyeyoung Kim & Hae Won Lee

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Kim, H., Suh, KS., Lee, KW. et al. Long-Term Outcome of Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Case-Controlled Study with Propensity Score Matching. Surg Endosc 28, 950–960 (2014). https://doi.org/10.1007/s00464-013-3254-3

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