Laparoscopic Hepatectomy is a Feasible and Safe Choice for Primary Hepatocellular Carcinoma Located at Favorable Location during the development period of a tertiary hospital: A case–control study

Abstract

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.