Short and long-term outcomes after laparoscopic or robotic liver resection in patients with HCC located in posterosuperior segments: comparision with open liver resection

Abstract

Introduction: Hepatocellular carcinoma located in posterosuperior segemtents, especially segments VII and VIII, are considered to be difficult for minimally invasive liver resection (MLR) because of limited visualization, the risk of major bleeding and difficulty in bleeding control. This study compared outcomes after laparoscopic or robotic liver resections for HCCs located in segments VII or VIII with open liver resections. Methods: Between January 2005 to December 2016, 497 patients underwent liver resections for HCCs located in segments VII or VIII. Among them, 63 patients underwent minimally invasive liver resection (MLR), which included 48 patients in laparoscope approach and 15 patients in robotic approach. We retrospectively evaluated perioperative and oncologic outcomes between the groups. Results: In terms of perioperative outcomes, operative time was longer for MLR group than open group (421 min. vs, 274 min., p< 0.001). While intraoperative blood loss was higher for open group (334 ml vs. 773ml, p< 0.001) and postoperative stay was longer (8.3 days vs. 17.5 days, p=0.001), there were no significant differences in postoperative complication rates (20.6% vs. 17.3%, p=0.596), In terms of oncologic outcomes, 5-year overall survival (85.5% vs. 79%, p=0.085) and 5-year disease survival (45.3% vs. 64.3%, p=0.489) rates did not show significant difference between MLR group and open group. Conclusion: MLR for HCC located in segments VII or VIII may be more time-consuming compared to open, but benefits of lower hospital stay and lower blood loss with same oncologic outcomes should make it a more attractive option in deciding operative procedure.