Surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma for various resection extent

Abstract

Although the number of laparoscopic liver resections (LRRs) has increased, studies of surgical outcomes in comparison with the conventional open approach are limited. The purpose of this study was to analyze the surgical outcomes (safety and efficacy) of LLR versus open liver resection (OLR) for hepatocellular carcinoma (HCC).We collected data on all patients who received liver resection for HCC between April 2015 and September 2016 in our institution, and retrospectively investigated the demographic and perioperative data, and also surgical outcomes.Laparoscopic liver resection was performed in 225 patients and OLR in 291. In patients who underwent minor hepatectomy, LLR associated with a shorter duration of operation time (200 vs 220 minutes; P < 0.001), less blood loss (100 vs 225 mL; P < 0.001), lower transfusion rate (3.0% vs 12.0%; P = 0.012), and shorter postoperative hospital stay (6 vs 7 days; P < 0.001) compared with OLR. Dietary recovery was relatively fast in the group of LLR, but there were no significant differences in hepatic inflow occlusion rate, complication rate, and transfusion volume. Patients who received major hepatectomy had a longer duration of operation (240 vs 230 minutes; P < 0.001), less blood loss (200 vs 400 mL; P < 0.001), lower transfusion rate (4.8% vs 16.5%; P = 0.002), lower hepatic inflow occlusion rate (68.3% vs 91.7%; P < 0.001), and shorter postoperative hospital stay (6 vs 8 days; P < 0.001). Complication rate (P = 0.366) and transfusion volume (P = 0.308) did not differ between groups.Laparoscopic liver resection is a feasible and safe alternative to OLR for HCC when performed by a surgeon experienced with the relevant surgical techniques, associated with less blood loss, lower transfusion rate, a rapid return to a normal diet, and shorter postoperative hospital stay with no compromise in complications. Further, long-term follow-up should be acquired for adequate evaluation for survival.

Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers

“…36 Either way, both CRLM and HCC represent the most amenable indications to LLR because of the earlier return to systemic therapy and parenchyma preserving benefits (possibly influencing reoperability) on one hand and because of the diminished manipulation, preservation of collaterals, and decreased decompensation and ascites production on the other hand. [37][38][39][40] Despite this, due to the increased chance of bleeding, cirrhosis is still treated with caution, as evidenced by the low percentage of cirrhotic patients in this series (Table 1). Of note, the altered liver background increases the difficulty of the procedure, increasing the probability of conversion, especially in demanding procedures, such as major hepatectomies and PS segment resections.…”

Laparoscopic versus open major liver resection for hepatocellular carcinoma: a case-matched analysis of short- and long-term outcomes

“…As showed in table 3, we have summarized all comparative studies of major LLR vs. major OLR [4][5][6][7][8][17][18][19][20][21][22][23]. The negative margins and oncologic integrity of the procedure should be obtained, when major laparoscopic liver resection is performed for cancer.…”

“…With regard to the data on perioperative outcomes, major LLR was associated with favorable intraoperative blood loss, total postoperative complications and postoperative hospital stay in the summarized comparative studies. However, the operation time of major LLR was significantly longer than major OLR in most of the retrospective studies [4][5][6][7][8][17][18][19]21,22]. Recently, the Japanese National Clinical Database showed that major LLR was associated with less blood loss, a lower complication rate and shorter hospital stay comparing with major OLR [26].…”

“…The second International Consensus Conference of Morioka recommended that LMH comprised innovative procedures in the exploration phase and could only be performed in those with experience of major open liver resections and advanced laparoscopic techniques [4]. With accumulating the development of new instruments, the introduction of novel techniques, the improvements in surgical skills and experience of LLR, some recent studies reported that LMH and OMH had similar oncologic outcomes in patients with hepatocellular carcinoma (HCC) [5][6][7][8]. However, just a few studies described the long-term oncologic outcomes of LMH for HCC.…”

Hepatocellular carcinoma: early-stage management challenges

“…Laparoscopy was associated with less blood loss, shorter hospital stay, and fewer postoperative complications 64. Multiple other groups have reported similar improvements in hospital length of stay and reduced complications 65–67…”