Laparoscopic Hepatectomy Versus Open Hepatectomy for the Management of Hepatocellular Carcinoma: A Comparative Study Using a Propensity Score Matching

Abstract

Objectives The aim of this study was to compare the results between laparoscopic hepatectomy and open hepatectomy in two French university hospitals, for the management of hepatocellular carcinoma (HCC) using a propensity score matching. Materials and methods A patient in the laparoscopic surgery group (LA) was randomly matched with another patient in the open approach group (OA) using a 1:1 allocated ratio with the nearest estimated propensity score. Matching criteria included age, presence of comorbidities, American Society of Anesthesiologists score, and resection type (major or minor). Patients of the LA group without matches were excluded. Intraoperative and postoperative data were compared in both groups. Survival was compared in both groups using the following matching criteria: number and size of lesions, alpha-fetoprotein rate, and cell differentiation. Results From January 2012 to January 2017, a total of 447 hepatectomies were consecutively performed, 99 hepatectomies of which were performed for the management of hepatocellular carcinomas. Forty-nine resections were performed among the open approach (OA) group (49%), and 50 resections were performed among the laparoscopic surgery (LA) group (51%). Mortality rate was 2% in the LA group and 4.1% in the OA group. After propensity score matching, there was a statistical difference favorable to the LA group regarding medical complications (54.55% versus 27.27%, p = 0.04), and operating times were shorter (p = 0.03). Resection rate R0 was similar between both groups: 90.91% (n = 30) in the LA group and 84.85% (n =) in the OA group. There was no difference regarding overall survival (p = 0.98) and recurrence-free survival (p = 0.42). Conclusions Laparoscopic liver resection for the management of HCC seems to provide the same short-term and long-term results as compared to the open approach. Laparoscopic liver resections could be considered as an alternative and become the gold standard in well-selected patients.

Short-term outcomes of laparoscopic versus open hepatectomy in the elderly patient: systematic review and meta-analysis

“…13 studies were included for meta-analysis. [29][30][31][32][33][34][35][36][37][38][39][40][41] An overview of study characteristics is summarized in Table 1. All studies were conducted retrospectively.…”

“…Propensity score matching was used in most studies. [30][31][32][33][34][35][36][37]40,41 [29][30][31][33][34][35][36][37]39,40 while two studies performed hand-assisted or hybrid approaches, 32,38 and one study did not specify the technique used. 41 The majority of included studies investigated minor hepatectomies only.…”

“…Three studies included several major hepatectomy cases. 29,33,37 One study focused on major hepatectomy only. 41 Eight studies were exclusively focused on an elderly population, [29][30][31][32]35,[39][40][41] with different cut-off ages (Table 1).…”

“…36 The remaining two studies had a mean age >65 and narrow ranges or standard deviations so the majority of the population was estimated to be > 65 years. 33,37 All patients had 29,[32][33][34][35][36][37]39,41 or cholangiocarcinoma. 39 One study focused on colorectal liver metastases, 40 while the remaining three studies included any malignant tumor as indication for surgery.…”

“…Generally, the risk of overall bias was estimated as moderate. [30][31][32][35][36][37][39][40][41] To reduce the risk of bias most studies used propensity score matching. Serious risk of confounding bias was estimated for three studies due to lack of matching for important confounders, such as comorbidities, tumor size/location, or extent of surgery.…”