Laparoscopic Hepatectomy Versus Open Hepatectomy for the Management of Hepatocellular Carcinoma: A Comparative Study Using a Propensity Score Matching
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.
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).
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Parks KR, Kuo Y-H, Davis JM, O’ Brien B, Hagopian EJ (2014) Laparoscopic versus open liver resection: a meta-analysis of long-term outcome. HPB 16(2):109–18Google Scholar
- 8.Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629Google Scholar
- 11.Bruix J, Sherman M (2005) Practice Guidelines Committee, American association for the study of liver diseases. Management of hepatocellular carcinoma. Hepatol Baltim Md 42(5):1208–1236Google Scholar
- 12.Bruix J, Sherman M (2011) American Association for the study of liver diseases. Management of hepatocellular carcinoma: an update. Hepatol Baltim Md 53(3):1020–1022Google Scholar
- 17.Couinaud C (1980) Definition of hepatic anatomical regions and their value during hepatectomy (author’s transl). Chir Mem Acad Chir 106(2):103–108Google Scholar
- 23.Singh A, Le P, Peerzada MM, Lopez R, Alkhouri N (2018) The utility of noninvasive scores in assessing the prevalence of nonalcoholic fatty liver disease and advanced fibrosis in type 2 diabetic patients. J Clin Gastroenterol 52(3):268–272Google Scholar
- 34.Cheung TT, Han HS, She WH, Chen KH, Chow PKH, Yoong BK et al (2018) The Asia Pacific consensus statement on laparoscopic liver resection for hepatocellular carcinoma: a report from the 7th Asia-Pacific primary liver cancer expert meeting held in Hong Kong. Liver Cancer 7(1):28–39CrossRefGoogle Scholar
- 37.Wu CC, Hwang CR, Liu TJ, P’eng FK (1996) Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver. Br J Surg 83(1):121–124Google Scholar
- 39.De Carlis L, Di Sandro S, Giacomoni A, Mihaylov P, Lauterio A, Mangoni I, et al. (2013) Colorectal liver metastases: hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39(7):726–733Google Scholar
- 42.Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, et al. (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102(1):82–86Google Scholar
- 55.Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N et al (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepato-Biliary-Pancreat Sci 22(10):721–727CrossRefGoogle Scholar
- 57.Han DH, Choi SH, Park EJ, Kang DR, Choi GH, Choi JS (2016) Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection. Int J Med Robot Comput Assist Surg MRCAS 12(4):735–742Google Scholar
- 59.Ahn KS, Kang KJ, Kim YH, Kim T-S, Lim TJ (2014) A propensity score-matched case-control comparative study of laparoscopic and open liver resection for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 24(12):872–827Google Scholar