Impact of conversion on the perioperative and long-term outcomes during laparoscopic hepatectomy for patient with hepatocellular carcinoma

Abstract

Introduction: Conversion is not unusual in laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC). Whether unplanned conversion would impair the perioperative and long-term outcomes of HCC remains controversial. Method: From January 2012 to June 2018, patients with HCC undergoing liver resection were retrospectively reviewed. Using a propensity score matching method, patients who experienced conversion were matched with those who completed LH and those performed open hepatectomy. Then, the perioperative outcomes and long-term survival were compared between each group. Result: During the study period, 708 and 1506 patients underwent laparoscopic and open hepatectomy, respectively. Of these, 60 patients (8.5%) experienced conversion to an open procedure during LH. Multivariate regression analysis showed that a history of upper abdominal surgery, posterolateral tumor location, and major hepatectomy were independent risk factors of conversion. After a 1:3 matching, 52 patient and 156 patients were enrolled in the final analysis. Conversion would deteriorate the intraoperative outcomes and increase postoperative complications. However, lethal complication is rare in both groups. The 1-, 3-, and 5-year disease-free survival rates were 77.0%, 63.6%, and 46.4%, respectively, in the laparoscopic group and 82.7%, 58.4%, and 58.4%, respectively, in the conversion group (P=0.698); while the overall survival rates were 92.1%, 77.5%, and 65.3%, respectively, in the laparoscopic group and 95.0%, 79.3%, and 63.4%, respectively, in the conversion group (P=0.822). There was no significant difference in survival outcomes. After a 1:8 matching with 1506 patients in the open group to eliminate the influence of confounding factors, the survival outcomes were also similar between the two groups. Conclusion: A history of upper abdominal surgery, central tumor location, and major hepatectomy are independent risk factors for conversion. Conversion would deteriorate the intraoperative outcomes and increase the total complications but not lethal complications. Timely conversion should be performed to avoid weakening the long-term survival of patients with HCC.