Abstract
BackgroundThe feasibility and safety of laparoscopic major hepatectomy (LMH) are still uncertain. The purpose of the present study is to compare the short- and long-term outcomes of LMH with those of open major hepatectomy (OMH) for hepatocellular carcinoma (HCC).MethodBetween January 2012 and December 2018, a total of 26 patients received laparoscopic major hepatectomy in our center. To minimize any confounding factors, a 1:3 case-matched analysis was conducted based on the demographics and extent of liver resection. Data of demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed.ResultsIntraoperative blood loss (P = 0.007) was significantly lower in the LMH group. In addition, the LMH group exhibited a lower overall complication rate (P = 0.039) and shorter postoperative hospital stay (P = 0.024). However, no statistically significant difference was found between LMH and OMH regarding operation time (P = 0.215) and operative cost (P = 0.860). Two laparoscopic cases were converted to open liver resection. In regard to long-term outcomes, there was no significant difference between LMH and OMH regarding disease-free survival (DFS) (P = 0.079) and overall survival (OS) (P = 0.172).ConclusionLMH can be an effective and safe alternative to OMH for selected patients with liver cancer in short- and long-term outcomes.
Highlights
Laparoscopic liver resection (LLR) has been increasingly utilized by surgeons since the first introduction of LLR in 1992 [1]
A total of 55 patients (70.5%) in the open major hepatectomy (OMH) group and 15 patients (57.7%) in the laparoscopic major hepatectomy (LMH) group (P = 0.227) were treated by portal triad clamping during hepatectomy
Less intraoperative blood loss was found in the LMH group than in the OMH group (340.8 ± 225.2 mL vs 601.4 ± 509.4 mL, P = 0.007); no significant difference between the LMH group and the OMH group was found in intraoperative transfusion (26.9 vs 29.5%, P = 0.803)
Summary
Laparoscopic liver resection (LLR) has been increasingly utilized by surgeons since the first introduction of LLR in 1992 [1]. With the continuous development in laparoscopic devices and approaches, laparoscopic minor resections have even become standard surgical procedures for treating solitary lesions located in liver segments 2–6 [2,3,4]. With accumulating the development of new instruments, the introduction of novel techniques, the improvements in surgical skills, and experience of LLR, some recent studies reported that LMH and OMH had similar oncologic outcomes in patients with hepatocellular carcinoma (HCC) [5,6,7,8]. Just a few studies described the long-term oncologic outcomes of LMH for HCC. The present study aimed to compare the short- and long-term outcomes between LMH and OMH in patients with hepatic disease, especially those with HCC
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