Research ArticleLaparoscopic versus open liver resection for hepatocellular carcinoma: Case-matched study with propensity score matching
Graphical abstract
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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