Outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy for hepatocellular carcinoma: a propensity score matching analysis
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Few studies had been performed to concern the outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy (LGAH) for hepatocellular carcinoma (HCC). The aim of this study was to compare the outcomes of LGAH versus open Glissonian pedicle approach hepatectomy (OGAH) for HCC, especially in patients with cirrhosis.
Hepatocellular carcinoma patients who underwent pure LGAH and OGAH between January 2015 and July 2017 in our institution were retrospectively enrolled in this study. Propensity score matching (PSM) of patients in a ratio of 1:1 was conducted to adjust the known confounders. The perioperative and oncological outcomes were compared between the two groups after PSM.
Some 80 patients underwent pure LGAH and 134 had OGAH. After PSM, 67 patients in each group were well matched for analysis. Both the postoperative overall complication rates (13.4% vs. 29.9%, P = 0.021) and mean comprehensive complication index (2.63 vs. 7.40, P = 0.035) were significantly lower in the LGAH group than those in OGAH group. Although the operative time was longer in the LRH group (P < 0.001), the length of postoperative hospital stay was shorter in the LRH group (P = 0.024). Furthermore, both the 3-year overall survival rate (73.3% for LGAH vs. 77.8% for OGAH, P = 0.338) and 3-year disease-free survival rate (56.4% for LGAH vs. 62.5% for OGAH, P = 0.455) were not significantly different between the groups.
Pure laparoscopic Glissonian approach may be a better alternative to open Glissonian approach in selected HCC patients, which provided fewer complications, shorter postoperative hospital stay and comparable oncological outcomes.
KeywordsLaparoscopic hepatectomy Open hepatectomy Glissonian approach Hepatocellular carcinoma
This work was supported by the National Natural Science Foundation of China (No. 81602910) and the Fundamental Research Fund for the Central Universities (No. 2017SCU11045).
Compliance with ethical standards
Drs. Fei Liu, Hongwei Xu, Qin Li, Yonggang Wei, Hongyu Li, Wentao Wang, Tianfu Wen, Hong Wu, Jiayin Yang, Mingqing Xu, and Bo Li have no conflict of interest or financial ties to disclose.
- 2.Lefor AT, Flowers JL (1994) Laparoscopic wedge biopsy of the liver. J Am Coll Surg 178:307–308Google Scholar
- 11.Lortat-Jacob JL, Robert HG, Henry C (1952) Case of right segmental hepatectomy. Memoires Academie de chirurgie 78(8–9):244–251Google Scholar
- 12.Launois B, Jamieson GG (1992) The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. Surg Gynecol Obstet 174:155–158Google Scholar
- 13.Takasaki K, Kobayashi S, Tanaka S et al (1990) Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg 75:73–77Google Scholar
- 16.Ramaciato G, Aurello P, D’Angelo F et al (1998) Effective vascular endostapler techniques in hepatic resection. Int Surg 83:317–323Google Scholar
- 17.Figueras J, Lopez-Ben S, Lladó L et al (2003) Hilar dissection versus the “glissonean” approach and stapling of the pedicle for major hepatectomies: a prospective, randomized trial. Ann Surg 238:111–119Google Scholar
- 18.Tsuruta K, Okamoto A, Toi M et al (2002) Impact of selective Glisson transection on survival of hepatocellular carcinoma. Hepatogastroenterology 49:1607–1610Google Scholar
- 26.Pang YY (2002) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339Google Scholar
- 33.Guo S, Fraser MW (2010) Propensity score analysis: statistical methods and applications. Advanced quantitative techniques in the social sciences series. SAGE Publications, Inc, Los AngelesGoogle Scholar
- 35.Wakabayashi G, Cherqui D, Geller DA 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