Laparoscopic liver resection in cirrhotic patients with hepatocellular carcinoma located in posterior segments: towards the “gold standard”?

Abstract

Background: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in the anterior segments of the liver is well described in the literature. The aim of this study is to evaluate retrospectively our results for LLR including only lesions in the posterior segments (PS) in terms of feasibility, outcome, recurrence and survival. Methods: Between 2001 and 2016, 30 patients underwent LLR and 51 patients open liver resection (OLR) for single HCC (≤5 cm) located in PS. The groups were selected according to predefined criteria. Results: There were not differences regarding BCLC staging, tumor size, etiology of cirrhosis and liver function. However, patients with HCC in segments 7 were more often treated by OLR. Although operation duration (208 min. OLR; 173 min. LLR; p=0.005), blood loss (282 ml OLR; 189 ml LLR; p=0.027), and length of postoperative stay (9 days OLR; 5 days LLR; p=0.001) were significantly better in the LLR group, postoperative complications (Dindo-Clavien >2) were similar (19% OLR; 10% LLR); no differences were found about surgical margins (8 mm OLR; 7 mm LLR). During a median follow-up of 44 months, no differences were found about the 5-year survival rate (44% OLR; 57% LLR), intra-hepatic recurrence rates at 5 years (46% OLR; 43% LLR) and local tumor progression (2% OLR; 0%, LLR). Conclusion: Although LLR is more difficult for HCC located in the PS, it seems to yield better short-term results as compared to OLR, and could well be considered a privileged approach in selected patients.