Surgical Endoscopy

, Volume 24, Issue 5, pp 1170–1176 | Cite as

Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study

  • Hadrien Tranchart
  • Giuseppe Di Giuro
  • Panagiotis Lainas
  • Jean Roudie
  • Helene Agostini
  • Dominique Franco
  • Ibrahim Dagher



Only a few series have demonstrated the safety of laparoscopic resection for hepatocellular carcinoma (HCC) and the benefits of this approach. Moreover, these studies reported mostly minor and nonanatomic hepatic resections. This report describes the results of a pair-matched comparative study between open and laparoscopic liver resections for HCC in a series of essentially anatomic resections.


Patients were retrospectively matched in pairs for the following criteria: sex, age, American Society of Anesthesiology (ASA) score, severity of liver disease, tumor size, and type of resection. A total of 42 patients undergoing laparoscopy were compared with patients undergoing laparotomy during the same period. Surgeons from the authors’ department not trained in laparoscopy performed open resections. Operative, postoperative, and oncologic outcomes were compared.


The mean duration of surgery was similar in the two groups. Significantly less bleeding was observed in the laparoscopic group (364.3 vs. 723.7 ml; p < 0.0001). Transfusion was required for four patients (9.5%) in the laparoscopic group and seven patients (16.7%) in the open surgery group (p = 0.51). Postoperative ascites was less frequent after laparoscopic resections (7.1 vs. 26.1%; p = 0.03). General morbidity was similar in the two groups (9.5 vs. 11.9%; p = 1.00). The mean hospital stay was significantly shorter for the patients undergoing laparoscopy (6.7 vs. 9.6 days; p < 0.0001). The surgical margin and local recurrence adjacent to the liver stump were not affected by laparoscopy. The overall postoperative survival rates in the laparoscopic group were 93.1% at 1 year, 74.4% at 3 years, and 59.5% at 5 years and, respectively, 81.8, 73, and 47.4% in the open surgery group (p = 0.25). The postoperative disease-free survival rates in the laparoscopic group were at 81.6% at 1 year, 60.9% at 3 years, and 45.6% at 5 years, respectively, 70.2, 54.3, and 37.2% in the open surgery group (p = 0.29).


Laparoscopic resection of HCC for selected patients gave a better postoperative outcome without oncologic consequences. Prospective trials are required to confirm these results.


Comparative study Hepatectomy Hepatocellular carcinoma Laparoscopy Liver 



Hadrien Tranchart, Giuseppe Di Giuro, Panagiotis Lainas, Jean Roudie, Helene Agostini, Dominique Franco, and Ibrahim Dagher have no conflicts of interest or financial ties to disclose.


  1. 1.
    Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, Wong J (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70CrossRefPubMedGoogle Scholar
  2. 2.
    Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y, Kubota K, Zucchi A (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg 134:984–992CrossRefPubMedGoogle Scholar
  3. 3.
    Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48(Suppl 1):S20–S37CrossRefPubMedGoogle Scholar
  4. 4.
    Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917CrossRefPubMedGoogle Scholar
  5. 5.
    Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J (2001) Clinical management of hepatocellular carcinoma: conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430Google Scholar
  6. 6.
    Chen HY, Juan CC, Ker CG (2008) Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol 15:800–806CrossRefPubMedGoogle Scholar
  7. 7.
    Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, Franco D (2008) Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 22:372–378CrossRefPubMedGoogle Scholar
  8. 8.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769CrossRefPubMedGoogle Scholar
  9. 9.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, Maeda T, Shiba T (2005) Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 189:190–194CrossRefPubMedGoogle Scholar
  10. 10.
    Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez PL (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506CrossRefPubMedGoogle Scholar
  11. 11.
    Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, Belli A (2007) Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 21:2004–2011CrossRefPubMedGoogle Scholar
  12. 12.
    Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, Tanaka S, Adachi E, Sugimachi K (2001) Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc 15:541–544CrossRefPubMedGoogle Scholar
  13. 13.
    Lai EC, Tang CN, Ha JP, Li MK (2009) Laparoscopic liver resection for hepatocellular carcinoma: 10-year experience in a single center. Arch Surg 144:143–147CrossRefPubMedGoogle Scholar
  14. 14.
    Tralhao JG, Kayal S, Dagher I, Sanhueza M, Vons C, Franco D (2007) Resection of hepatocellular carcinoma: the effect of surgical margin and blood transfusion on long-term survival: analysis of 209 consecutive patients. Hepatogastroenterology 54:1200–1206PubMedGoogle Scholar
  15. 15.
    Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526PubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedGoogle Scholar
  17. 17.
    Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46CrossRefPubMedGoogle Scholar
  18. 18.
    Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, Takayama T, Makuuchi M (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206CrossRefPubMedGoogle Scholar
  19. 19.
    Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330CrossRefPubMedGoogle Scholar
  20. 20.
    Laurent A, Tayar C, Andreoletti M, Lauzet JY, Merle JC, Cherqui D (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreatic Surg 16:310–314CrossRefGoogle Scholar
  21. 21.
    Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, Sano K, Sugawara Y, Takayama T, Makuuchi M (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259CrossRefPubMedGoogle Scholar
  22. 22.
    Regimbeau JM, Kianmanesh R, Farges O, Dondero F, Sauvanet A, Belghiti J (2002) Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma. Surgery 131:311–317CrossRefPubMedGoogle Scholar
  23. 23.
    Wakai T, Shirai Y, Sakata J, Kaneko K, Cruz PV, Akazawa K, Hatakeyama K (2007) Anatomic resection independently improves long-term survival in patients with T1–T2 hepatocellular carcinoma. Ann Surg Oncol 14:1356–1365CrossRefPubMedGoogle Scholar
  24. 24.
    Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K (1993) The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinoma. Cancer 72:1866–1871CrossRefPubMedGoogle Scholar
  25. 25.
    Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309PubMedGoogle Scholar
  26. 26.
    Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, D’Angelica MI, Blumgart LH, Dematteo RP (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249:617–623CrossRefPubMedGoogle Scholar
  27. 27.
    Abdel-Atty MY, Farges O, Jagot P, Belghiti J (1999) Laparoscopy extends the indications for liver resection in patients with cirrhosis. Br J Surg 86:1397–1400CrossRefPubMedGoogle Scholar
  28. 28.
    Fong Y, Jarnagin W, Conlon KC, DeMatteo R, Dougherty E, Blumgart LH (2000) Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg 135:854–859CrossRefPubMedGoogle Scholar
  29. 29.
    Huang MT, Wei PL, Wang W, Li CJ, Lee YC, Wu CH (2009) A series of laparoscopic liver resections with or without HALS in patients with hepatic tumors. J Gastrointest Surg 13:896–906CrossRefPubMedGoogle Scholar
  30. 30.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL (2003) Laparoscopic versus open left lateral hepatic lobectomy: a case-control study. J Am Coll Surg 196:236–242CrossRefPubMedGoogle Scholar
  31. 31.
    Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, Lau WY, Li JQ (2007) Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial. Ann Surg 245:36–43CrossRefPubMedGoogle Scholar
  32. 32.
    Schaeff B, Paolucci V, Thomopoulos J (1998) Port-site recurrences after laparoscopic surgery: a review. Dig Surg 15:124–134CrossRefPubMedGoogle Scholar
  33. 33.
    Silecchia G, Perrotta N, Giraudo G, Salval M, Parini U, Feliciotti F, Lezoche E, Morino M, Melotti G, Carlini M, Rosato P, Basso N (2002) Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rectum 45:1172–1177CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Hadrien Tranchart
    • 1
  • Giuseppe Di Giuro
    • 1
  • Panagiotis Lainas
    • 1
  • Jean Roudie
    • 2
  • Helene Agostini
    • 3
  • Dominique Franco
    • 1
    • 4
  • Ibrahim Dagher
    • 1
    • 4
  1. 1.Department of General SurgeryAntoine Béclère HospitalClamart CedexFrance
  2. 2.Department of General SurgeryChu de Fort-de-FranceMartiniqueFrance
  3. 3.Clinical Research Unit APHPAntoine Béclère HospitalClamart CedexFrance
  4. 4.Universite Paris-SudOrsayFrance

Personalised recommendations