Comparison of Clinical Outcome between Minimally Invasive and Open Hepatectomy at High Difficulty Score for Hepatocellular Carcinoma

Abstract

Introduction: Minimally invasive (MIS) hepatectomy at high difficulty score for hepatocellular carcinoma (HCC) is controversial. Method: From 2004 to 2019, there were 338 patients (MIS group n = 35, open group n = 303) undergone hepatectomy at high difficulty score (score 7 – 10) for HCC. Propensity score (PS) matching was performed between two groups. Short-term and long-term outcomes were compared. Univariate and multivariate analyses was performed to identify prognostic factors affecting overall and disease-free survival. Results: After PS matching, there were 35 patients in MIS group and 70 patients in open group. Compared with open group, MIS group had less blood loss (150 mL vs. 360 mL), longer operative time (375 min vs. 250 min) and shorter hospital stay (6 days vs. 7 days). The R0 resection rate, hospital mortality, severe complication rate and hospital stay were similar between two groups. With a median follow-up of 24 months, there was no difference in tumor recurrence rate (MIS group: 25.7%; open group: 47.1%). There was no significant difference in 5-year overall survival rate between MIS and open groups (85.9% vs. 71.6%) (P = 0.083). The 5-year disease-free survival rate was also comparable between two groups (66.2% vs. 45.2%) (P = 0.199). Serum albumin, cirrhosis, intraoperative blood loss and postoperative complication, but not surgical approach (MIS vs. open), were associated with poor disease-free survival. Conclusions: MIS hepatectomy at high difficulty score for HCC can achieve similar clinical outcomes in selected patients as those with open approach.