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Laparoscopic versus open limited liver resection for hepatocellular carcinoma with liver cirrhosis: a propensity score matching study with the Hiroshima Surgical study group of Clinical Oncology (HiSCO)

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Abstract

Background

Laparoscopic liver resection (LLR) has evolved as a safe and effective alternative to conventional open liver resection (OLR) for malignant lesions. However, LLR in cirrhotic patients remains challenging. This study analyzed the perioperative and oncological outcomes of LLR for hepatocellular carcinoma (HCC) with cirrhosis compared with OLR using propensity score matching.

Methods

A multicenter retrospective analysis of records of patients who underwent limited liver resection for HCC and were histologically diagnosed with liver cirrhosis between January 2009 and December 2017 in the eight institutions belonging to the Hiroshima Surgical study group of Clinical Oncology was performed. The patients were divided into two groups: the LLR and OLR groups. After propensity score matching, we compared clinicopathological features and outcomes.

Results

In total 256 patients with histological liver cirrhosis who underwent limited liver resection for HCC were included in this study; 58 patients had undergone LLR, and the remaining 198 patients OLR. The number of tumors was higher, tumor size was larger, and difficulty score was significantly higher in the OLR group before propensity matching. After the matching, the data of the well-matched 58 patients in each group were evaluated; the intraoperative blood loss was lower in the LLR group (p = 0.004), and incidence of the postoperative complications was significantly higher in the OLR group (p = 0.019). The duration of the postoperative hospital stay was significantly shorter in the LLR group (p < 0.001). There were no differences between two groups in overall survival and recurrent-free survival.

Conclusions

LLR decreased the incidences of postoperative complications, shortened the duration of postoperative hospital stay. Thus, LLR is a safe and feasible procedure even in patients with cirrhosis.

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Acknowledgments

All authors performed this procedure. This study was not funded by any grants. We would like to thank Editage (www.editage.jp) for English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University Hospital, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8551, Japan

    Masateru Yamamoto, Tsuyoshi Kobayashi, Naruhiko Honmyo & Hideki Ohdan

  2. Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami Ward, Hiroshima, 734-8530, Japan

    Akihiko Oshita

  3. Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan

    Tomoyuki Abe

  4. Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita Ward, Hiroshima, 731-0293, Japan

    Toshihiko Kohashi

  5. National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Institute for Clinical Research, 3-1, Aoyamacho, Kure, Hiroshima, 737-0023, Japan

    Takashi Onoe

  6. Department of Surgery, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, 737-0193, Japan

    Saburo Fukuda

  7. Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513, Jike, Saijyo-cho, Higashihiroshima, Hiroshima, 739-0041, Japan

    Ichiro Omori

  8. Department of Surgery, National Hospital Organization Hiroshima-Nishi Medical Center, 4-1-1 Kuba, Otake, Hiroshima, 739-0696, Japan

    Yasuhiro Imaoka

Authors
  1. Masateru Yamamoto
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  2. Tsuyoshi Kobayashi
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  3. Akihiko Oshita
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  4. Tomoyuki Abe
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  5. Toshihiko Kohashi
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  6. Takashi Onoe
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  7. Saburo Fukuda
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  8. Ichiro Omori
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  9. Yasuhiro Imaoka
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  10. Naruhiko Honmyo
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  11. Hideki Ohdan
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Corresponding author

Correspondence to Tsuyoshi Kobayashi.

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Disclosures

Drs. Masateru Yamamoto, Tsuyoshi Kobayashi, Akihiko Oshita, Tomoyuki Abe, Toshihiko Kohashi, Takashi Onoe, Saburo Fukuda, Ichiro Omori, Yasuhiro Imaoka, Naruhiko Honmyo, and Hideki Ohdan have no conflicts of interest or financial ties to disclose.

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Yamamoto, M., Kobayashi, T., Oshita, A. et al. Laparoscopic versus open limited liver resection for hepatocellular carcinoma with liver cirrhosis: a propensity score matching study with the Hiroshima Surgical study group of Clinical Oncology (HiSCO). Surg Endosc 34, 5055–5061 (2020). https://doi.org/10.1007/s00464-019-07302-y

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  • DOI: https://doi.org/10.1007/s00464-019-07302-y

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