Laparoscopic Liver Resection Should Be a Standard Procedure for Hepatocellular Carcinoma with Low or Intermediate Difficulty.

Ruoh-Yun Gau,Chien-Chih Chiu,Cheng-Han Lee,Hsin-I Tsai,Kun-Ming Chan,Kuan-Chieh Lee,Tony Kuo,Ming-Chin Yu,Chao-Wei Lee,Wei-Chen Lee

doi:10.3390/jpm11040266

Abstract

Background: To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC), we compared the outcome between LLR and conventional open liver resection (OLR) in patient groups with different IWATE criteria difficulty scores (DS). Methods: We retrospectively reviewed 607 primary HCC patients (LLR: 81, OLR: 526) who underwent liver resection in Linkou Chang Gung Memorial hospital from 2012 to 2019. By using 1:1 propensity score-matched (PSM) analysis, their baseline characteristics and the DS stratified by the IWATE criteria were matched between the LLR and OLR. Their perioperative and oncologic outcomes were compared. Results: After 1:1 PSM, 146 patients (73 in LLR, 73 in OLR) were analyzed. Among them, 13, 41, 13 and 6 patients were classified as low, intermediate, advanced and expert DS group, respectively. Compared to OLR, the LLR had shorter hospital stay (9.4 vs. 11.5 days, p = 0.071), less occurrence of surgical complications (16.4% vs. 30.1%, p = 0.049), lower rate of hepatic inflow control (42.5% vs. 65.8%, p = 0.005), and longer time of inflow control (70 vs. 51 min, p = 0.022). The disease-free survival (DFS) and overall survivals were comparable between the two groups. While stratified by the DS groups, the LLR tended to have lower complication rate and shorter hospital stay than OLR. The DFS of LLR in the intermediate DS group was superior to that of the OLR (p = 0.020). In the advanced and expert DS groups, there were no significant differences regarding outcomes between the two groups. Conclusion: We have demonstrated that with sufficient experience and technique, LLR for HCC is feasible and the perioperative outcome is favorable. Based on the current study, we suggest LLR should be a standard procedure for HCC with low or intermediate difficulty. It can provide satisfactory postoperative recovery and comparable oncological outcomes. Further larger scale prospective studies are warranted to validate our findings.

Highlights

As a promising minimally invasive technique, laparoscopic liver resection (LLR)has been widely adopted in recent decades [1]
Owing to the application of semiannual surveillance program, the increased proportion of tumors diagnosed at an earlier stage, and advancing surgical techniques as well as perioperative care, the overall survival of hepatocellular carcinoma (HCC) patients after liver resection is improving in the recent decades [9]
After the first international consensus conference for laparoscopic liver resection (ICCLLR), we reported our experience regarding laparoscopic left lateral sectionectomy (LLS) for HCC [7,30]

Summary

Introduction

As a promising minimally invasive technique, laparoscopic liver resection (LLR)has been widely adopted in recent decades [1]. To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC), we compared the outcome between LLR and conventional open liver resection (OLR) in patient groups with different IWATE criteria difficulty scores (DS). By using 1:1 propensity score-matched (PSM) analysis, their baseline characteristics and the DS stratified by the IWATE criteria were matched between the LLR and OLR. Their perioperative and oncologic outcomes were compared. While stratified by the DS groups, the LLR tended to have lower complication rate and shorter hospital stay than OLR.

Methods

Results

Discussion

Conclusion