Laparoscopic versus open liver resection for hepatocellular carcinoma in a UK population: a single centre experience

Abstract

Aims: Since mid-1970s liver cancer incidence rate increased overall in Great Britain, being now the 18th most common cancer in England. The aim of this study was to analyse our ten-years results related to hepatocellular carcinoma (HCC) treatment in a UK population, comparing surgical and oncologic outcomes obtained by laparoscopic versus open approach. Methods: Between January 2005 and December 2014, sixty-two hepatic resection for HCC were performed at our Institution. Patients were divided in two groups: A- patients undergoing open liver resection (OLR), B- patients undergoing laparoscopic liver resection (LLR). Intraoperative, postoperative and oncologic outcomes were analysed and compared between the two groups. A subgroup analysis of patients with lesions >5 cm was performed to assess the impact of size on outcomes and patients selection to the laparoscopic approach. Results: Twenty-six OLR and thirty-six LLR were performed. There were no statistical differences in demographic parameters, incidence of cirrhosis, operative time, margin status, perioperative mortality rate and DFS between the two groups. The median size of the tumours was significantly higher in the open group 8.6 cm vs 5.5 cm (p=0.035). Patients undergoing LLR had lower blood loss (p=0.033), shorter high dependency unit (p=0.005) and general hospital-stay (p=0.001) and lower 30-days morbidity rate (p=0.003). Median global survival was 58 months: surprising LLR did positively influenced OS (p=0.047), with a median survival of 68 months versus the 38 months accomplished with OLR. Laparoscopic approach confirmed favourable outcomes in both perioperative and on oncologic fields also for tumours major than 5 cm in size. Conclusions: Despite the lower incidence of liver cancer in UK, an increasing number of HCC has been noticed since the early 1990s. Our ten-years experience demonstrates that LLR for HCC is feasible and safe, conferring the widely accepted benefits arising from a mini-invasive approach, and ensuring both perioperative and oncologic favourable outcomes.