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Comparison between laparoscopic liver resection and open liver resection in patients with hepatocellular carcinoma with portal vein tumor thrombosis

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Abstract

Background

Recently, the outcomes of surgical treatment for advanced hepatocellular carcinoma (HCC) have improved. However, despite the technical advancements in laparoscopic liver resection (LLR), it is still not recommended as the standard treatment for HCC with portal vein tumor thrombosis (PVTT) because of the poor oncological outcomes. This study aims to compare the clinical outcomes of open liver resection (OLR) and LLR in patients with HCC with PVTT.

Methods

A total of 86 patients with PVTT confirmed in the pathological report between January 2014 and December 2018, were enrolled. Short-term, postoperative, and long-term outcomes, including recurrence-free survival and overall survival rates, were evaluated.

Results

No difference between the two groups, except for age, was detected. The median age in the laparoscopic group was significantly higher than that in the open group. Regarding the pathological features, the maximal tumor size was significantly larger in the OLR; other pathological factors did not differ. There was no significant difference between overall survival (OS) and recurrence-free survival (RFS). Vp3 PVTT (hazards ratio [HR] 6.1, 95% confidence interval [CI] 1.9–18.5), Edmondson grade IV (HR 4.7, 95% CI 1.7–12.9, p = 0.003), and intrahepatic metastasis (HR 3.9, 95% CI 2.1–7.2, p < 0.001) remained the unique independent predictors of recurrence-free survival according to a multivariate Cox proportional hazard regression analysis.

Conclusions

Laparoscopic liver resection for the management of HCC with PVTT provides the same short- and long-term results as those of the open approach.

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Authors and Affiliations

  1. Department of Surgery, Hanyang University School of Medicine, Seoul, Republic of Korea

    Kyeong Sik Kim

  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwin-ro, Gangnam-gu, Seoul, 06351, South Korea

    Gyu-Seong Choi, Jinsoo Rhu & Jongman Kim

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  1. Kyeong Sik Kim
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Correspondence to Jongman Kim.

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Kyeong Sik Kim, Gyu-Seong Choi, Jinsoo Rhu and Jongman Kim have no conflicts of interest or financial ties to disclose.

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Kim, K.S., Choi, GS., Rhu, J. et al. Comparison between laparoscopic liver resection and open liver resection in patients with hepatocellular carcinoma with portal vein tumor thrombosis. Surg Endosc 38, 2116–2123 (2024). https://doi.org/10.1007/s00464-024-10732-y

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  • DOI: https://doi.org/10.1007/s00464-024-10732-y

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