Elsevier

Journal of Hepatology

Volume 63, Issue 3, September 2015, Pages 643-650
Journal of Hepatology

Research Article
Laparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching

https://doi.org/10.1016/j.jhep.2015.04.005Get rights and content

Background & Aims

Laparoscopic liver resection has gained wide acceptance and is established as a safe alternative to open liver resection. Until now, there is no prospective randomized comparative study between laparoscopic and open liver resection. Previous comparative studies reported minor resections for peripheral tumors, and enrolled small numbers of patients. Moreover, few reported the long term outcomes. The aim of this study is to compare perioperative and long term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma between two matched groups.

Methods

389 patients underwent liver resection for hepatocellular carcinoma during the period between 2004 and 2013. To overcome selection bias, we performed 1:1 match using propensity score matching between laparoscopic and open liver resection.

Results

After propensity score matching, 88 patients were included in each group. Laparoscopic group had shorter hospital stay (8 vs. 10 days, p ⩽0.001), and lower postoperative morbidity (12.5% vs. 20.4%, p = 0.042). The 1-, 3- and 5-year overall survivals were 91.6%, 87.5%, and 76.4%, for laparoscopic group, and were 93.1%, 87.8%, and 73.2%, for open group (p = 0.944). The 1-, 3- and 5-year disease free survivals were 69.7%, 52%, and 44.2%, for laparoscopic group, and 74.7%, 49.5%, 41.2%, for open group (p = 0.944).

Conclusions

Our study showed comparative perioperative and long term outcomes between both groups, providing evidence regarding the safety and efficacy of laparoscopic liver resection for hepatocellular carcinoma.

Introduction

Since the first description in 1992 [1], laparoscopic liver resection (LLR) has become widely accepted and is established as a safe alternative to open liver resection (OLR) [2]. Nowadays, LLR has become the standard procedure for left lateral sectionectomy [3]. The introduction of new surgical equipment and the increased experience in this procedure allowed major liver resections to be performed more frequently and safely than before [4].

Many studies reported favourable results after LLR for HCC [5], [6], [7], [8], [9], [10], [11], [12]. However, most of these studies reported left lateral sectionectomy and minor hepatic resections for peripherally located tumors, and reported small numbers of patients [6], [7], [8], [9]. Moreover, few reports have described the long term oncological outcomes of LLR for HCC [11], [12].

Up to now, there is no prospective randomized comparative study comparing the outcomes between LLR and OLR. In clinical practice, it is difficult to perform a prospective randomized study to compare the outcomes between different surgical procedures. Propensity score matching (PSM) has been proposed as a method to overcome selection bias and increase the evidence level in observational non-randomized studies [13].

The aim of this study is to compare perioperative and postoperative long term outcomes of LLR and OLR for HCC utilizing PSM.

Section snippets

Study design

We retrospectively reviewed the data for all patients who underwent either LLR or OLR for HCC at Seoul National University Bundang Hospital during the period between January 2004 and December 2013.

Preoperative evaluation

All patients underwent detailed laboratory evaluation including complete blood count, liver function tests, serum α-feto-protein, blood glucose, and indocyanine green clearance (15 min). The diagnosis and staging of HCC were done by triphasic computed tomography of the abdomen. Some patients were also

Results

During the study period, 389 patients underwent liver resection for HCC. Two hundred and thirty-two patients underwent LLR and 157 underwent OLR. Fig. 1, shows the yearly adoption rates of laparoscopic liver resection for HCC during the ten years of the study. Eighteen patients were excluded due to the duplicate of data, and three patients were excluded due to missing data (one patient missed the α-feto-protein, and two patients missed follow up). We finally had 368 patients (222 LLR and 146

Discussion

HCC is the fifth most common cancer worldwide, with nearly 90% of the cases associated with chronic liver disease. Liver resection remains the main stay of treatment in patients with adequate liver reserve [20]. LLR has been widely accepted and safely used as an alternative to OLR [2].

In our institution, our adoption rate of LLR for HCC was around 50% until 2009. Since 2010, the adoption rate increased up to 78% in 2013. Recently, many reports showed the potential advantages of this procedure

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Author’s contributions

  • Conception and design of the study: Han HS and Shehta A.

  • Collection and assembly of the data: Shehta A.

  • Data analysis and interpretation: Ahn S and Shehta A.

  • Drafting the manuscript: all authors.

  • Critical revision of the manuscript for important intellectual content: all authors.

  • Final approval of the manuscript: all authors.

  • Study supervision: Han HS.

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