Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score-matched analysis

Abstract

BackgroundLaparoscopic major hepatectomy (LMH) for hepatocellular carcinoma (HCC) in patients with cirrhosis remains controversial due to limited reports in the literature. This study analyzed the perioperative and oncological outcomes of LMH for HCC with cirrhosis compared with open major hepatectomy (OMH).MethodsA retrospective analysis of patients with cirrhosis who underwent major hepatectomy for HCC between January 2015 and January 2017 was performed. Patients were divided into the LMH group and the OMH group. Short-term and oncological outcomes were compared before and after 1:1 propensity score matching (PSM).ResultsA total of 103 HCC patients who received major liver resection were enrolled. There were 36 (35.0%) patients in the LMH group and 67 (65.0%) patients in the OMH group. After 1:1 PSM, well-matched 32 patients in each group were evaluated. Significant differences were observed in operative time (median, 255 vs. 200 min, p < 0.001) and Pringle time (median, 50 vs. 30 min, p < 0.001) between two groups. The blood loss and transfusion requirement were comparable in two groups. The rate of overall postoperative complications did not differ between two groups, while the incidence of ascites in the LMH group was significantly less than OMH group (9.4 vs. 31.3%, p = 0.030). The oncological outcomes between the two groups were comparable with regard to 2-year overall survival (85.7 vs. 86.7%, p = 0.694) and disease-free survival (72.9 vs. 81.5%, p = 0.990), respectively.ConclusionsLMH for HCC patients with liver cirrhosis showed comparable results in terms of postoperative morbidity and oncological outcomes compared with traditional open procedure. LMH may serve as a safe and feasible alternative for selected HCC patients with cirrhosis.

Meta‐analysis of laparoscopic versus open liver resection for hepatocellular carcinoma

“…14); there were no missing studies in the overall morbidity group and the 3-DFS group were identified by the trim-and-fill method using fixed-effect model (Figs. [16][17][18][19][20]. The trend of the results did not change, showing our results were reliable.…”

“…Through the preliminary search, 990 articles are obtained. After reading titles and abstracts and full texts and removing duplicate documents, 47 articles were included in our study, which involved 5889 patients (Fig. ).…”

“…Hence, we assessed the quality of all the included studies with MINORS. The included studies were methodologically adequate with low heterogeneity regarding their quality, providing a mean score of 18.8 (standard deviation, 1.59) and a median score of 19 (range, [15][16][17][18][19][20][21]. According to Abraham et al, quality NRCTs are probably as accurate as RCTs for meta-analyses of surgical procedures.…”

Possible underestimation of blood loss during laparoscopic hepatectomy

“…Following the second ICCLLR, three case‐matched studies with propensity score analysis using Japanese multicentre series or National Clinical Database information demonstrated significantly less intraoperative BL in laparoscopic versus open hepatectomy. However, the intraoperative BL was equivalent for laparoscopic and open hepatectomy in comparative studies using propensity score matching reported from Korea and China, and in an RCT from Norway focusing on minor hepatectomy for colorectal liver metastases.…”

Robotic vs laparoscopic hemihepatectomy: A comparative study from a single center

“…According to the Second International Consensus Conference for Laparoscopic Liver Resection, minor liver resections, such as left lateral sectionectomy, have become a standard practice, while laparoscopic major liver resections remain in an exploration phase . Furthermore, reports on laparoscopic major hepatectomy from various centers have showed controversial short‐ and long‐term outcomes …”