Laparoscopic Liver Resection Can Be a Standard Treatment for Hepatocellular Carcinoma of Low and Intermediate Difficulty

Abstract

Introduction: To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) with various difficulty, we compared LLR and open liver resection (OLR) in serial patient groups with matched difficulty level. Methods: We retrospectively reviewed 607 patients with HCC undergoing liver resection (81 of LLR, 526 of OLR) in our hospital from 2012 to 2019. Propensity score-matched (PSM) analysis was used to balance LLR and OLR with characteristics and difficulty levels by IWATE criteria. We compared the matched patients, and further analyzed the results in patient groups stratified by difficulty score (DS). Results: After 1:1 PSM process, 146 patients were selected. Compared to OLR, LLR had shorter hospital stay (9.4 vs. 11.5 days, p=0.071), less surgical complications (16.4% vs. 30.1%, p=0.049), lower inflow control rate (42.5% vs. 65.8%, p=0.005), while comparable disease-free and overall survival. Among the 73 matched patients of each group, 13, 41, 13 and 6 patients were classified as low, intermediate, advanced and expert DS group, respectively. Accordingly, LLR was associated with shorter hospital stay and less surgical complications in low and intermediate DS groups. The disease-free survival of LLR in intermediate DS group was superior to OLR (p=0.020). In advanced and expert DS groups, the peri-operative and oncologic outcomes between LLR and OLR were comparable. Conclusions: With careful patient selection, LLR for HCC had promising outcome in comparison to OLR. Our data suggest that LLR should be considered a standard procedure in HCC case of low and intermediate difficulty according to IWATE criteria.Tabled 1Comparison of clinical and oncologic outcomes between LLR and OLR after propensity score matching analysisMatched-LLR (n=73(100%))Matched-OLR (n=73(100%))P valueHepatic inflow control (Yes (n(%))31 (42.5)48 (65.8)0.005Grade ≧II complication (n(%))12 (16.4)22 (30.1)0.049Grade ≧III complication (n(%))2 (2.7)7 (9.6)0.166In-hospital mortality (n(%))0 (0.0)2 (2.7)0.497Surgical time (min) (mean±SD)288.6±102.1276.0±106.70.501Blood loss (ml) (mean±SD)342.5±394.4400.7±531.90.456Post-OP length of hospital stay (day) (mean±SD)9.4±5.311.5±9.80.071Positive resection margin (n(%))1 (1.4)4 (5.5)0.172Follow up period (month) (mean±SD)38.4±26.946.2±24.20.083 Open table in a new tab