Background Laparoscopic hepatectomy (LH) for hepatocellular carcinoma (HCC) has been well-known for its advantages in the past 10 years, but little is known regarding its oncologic outcomes while the technique is being developed at an institution. This study aimed to evaluate the safety and effectiveness of LH for patients with primary HCC at favorable locations, focusing on postoperative short-, and long-term outcomes during the development period. Methods We retrospectively reviewed patients diagnosed with primary HCC that underwent hepatectomy between January 2013 and December 2019 at Hualien Tzu Chi Hospital. Patients with HCC at favorable locations (anterolateral segments) were collected and divided into laparoscopic and open hepatectomy (OH) groups. The primary end point was long-term oncologic outcomes, including overall, and disease-free survival, whereas the secondary end point was postoperative short-term outcomes. Results The review included 159 patients, and among which 42, and 44 patients with HCC in favorable locations were underwent open and laparoscopic hepatectomies. There were no significant differences in intraoperative blood loss (200 vs. 300 mL, p = 0.072), overall complication rate (57.2% vs. 36.4%, p = 0.083), major complication rate (11.9% vs. 2.3%, p = 0.080), and 90-day mortality rate (7.1% vs. 0.0%, p =0.071) between the two groups. The laparoscopic group had a lower transfusion rate (14.3% vs. 2.3%, p = 0.042), shorter post-operative hospital stay (10 days vs. 7 days, p < 0.001), and lower 90-day readmission rate (14.3% vs. 2.3%, p = 0,042). There were no significant differences in 12-, 36,- and 60-month overall survival and disease-free survival. Conclusions LH for favorably located HCC is the preferred surgical approach compared to OH due to the decreased transfusion rate, shorter postoperative hospital stay, and lower 90-day readmission rate. LH did not compromise the 90-day mortality rate with sustained long-term overall and disease-free survival. LH for favorably located HCC is a safe and effective surgical approach even during the development period.

A BSTRACT Objectives: Laparoscopic hepatectomy (LH) is still technically challenging for patients with previous nonhepatectomy abdominal surgery (AS). Therefore, this study aimed to assess the difficulty of performing LH for patients with hepatocellular carcinoma (HCC) and a history of nonhepatectomy AS during the initial developing period of LH. Materials and Methods: The retrospective study enrolled patients who were newly diagnosed with HCC receiving LH from January 2013 to June 2021. Demographic characteristics, perioperative variables, and surgical complications were prospectively collected. Results: One hundred patients were reviewed consecutively, comprising 23 in the AS group and 77 in the non-AS group. No significant differences were observed in median IWATE score (5 vs. 5, P = 0.194), operative time (219 vs. 200 min, P = 0.609), blood loss (100.0 vs. 200.0 mL, P = 0.734), transfusion rate (4.3% vs. 10.4%, P = 0.374), duration of parenchyma transection (90.0 vs. 72.4 min, P = 0.673), and mean nonparenchymal transection time (191.0 vs. 125.0 min, P = 0.228), without increasing the conversion rate (0.0% vs. 3.9%, P = 0.336), postoperative complications (30.3% vs. 33.8%, P = 0.488), and postoperative hospital stay (6 vs. 7 days, P = 0.060) in AS group and non-AS groups. Conclusion: History of previous nonhepatectomy AS can lead to longer nonparenchymal transection time instead of conversion and did not increase the difficulty. Prolonged nonparenchymal transection time did not increase the surgical complications, prolong the postoperative hospital stay, and compromise the survival outcomes.