Long-term and perioperative outcome evaluation of pure laparoscopic liver resection versus open liver resection for hepatocellular carcinoma

Abstract

Introduction: With the increase of laparoscopic approaches related to HCC, the oncological adequacy of laparoscopic liver resection (LLR) compared with open liver resection (OLR) has become an important topic of debate. This study aimed to compare the perioperative and long-term oncological outcomes of LLR with those of OLR for hepatocellular carcinoma (HCC) using propensity score matching (PSM). Methods: We retrospectively reviewed medical records of patients with HCC who underwent liver resection between July 2007 and April 2016 at our center. A total of 2335 patients were included in this study and divided into LLR (n=264) and OLR (n=2071) groups. Results: After 1:2 PSM , there were 217 and 434 patients in the LLR and OLR groups, respectively. The LLR group had a shorter hospital stay (8.9 vs. 14.8 days, P< 0.001) and lower postoperative morbidity (6.5% vs. 12.0%, P=0.022). The 1-, 3-, and 5-year overall survival rates were 98.1%, 87.0%, and 78.6%, respectively, in the LLR group, and 98.3%, 90.8%, and 84.3%, respectively, in the OLR group (P=0.570). The 1-, 3-, and 5-year disease-free survival rates were 81.0%, 62.0%, and 49.1%, respectively, in the LLR group, and 85.3%, 64.7%, and 56.2%, respectively, in the OLR group (P=0.563). Conclusions: Long-term oncological outcomes were comparable between LLR and OLR for selected patients. LLR was associated with multiple benefits, even in selected patients with cirrhosis who underwent major hepatectomy. LLR for HCC performed by an experienced surgeon could be considered as a safe and feasible alternative to OLR in selected patients.