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Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center

Surgical Endoscopy volume 32, pages 790–798 (2018)Cite this article

Abstract

Background

Anatomical hepatectomy is an ideal curative treatment for hepatocellular carcinoma (HCC). We have standardized our laparoscopic anatomical hepatectomy (LAH) procedure, gradually extending its indications. In the present study, we describe our experience and the perioperative and oncological outcomes of LAH for HCC compared to those of open anatomical hepatectomy (OAH) during the gradual introduction of LAH.

Methods

Seventy patients with primary HCC underwent anatomical hepatectomy in our institution from November 2008 to April 2014. As we gained experience with LAH, our indications for choosing LAH over OAH gradually expanded. Ultimately, 40 and 30 patients underwent LAH and OAH, respectively. Perioperative and oncological outcomes were compared between the two groups.

Results

There were no significant differences in age, sex, background of liver disease, liver function, tumor size, tumor number, or type of liver resection between the two groups. Major complications and mortality rates were similar between the LAH and OAH groups (12.5% vs. 20%; p = 0.582, and 0% vs. 3.3%; p = 0.429, respectively). The median follow-up time after surgery was 40.5 months in the LAH group and 32.9 months in the OAH group (p = 0.835). The 1-, 3-, and 5-year overall survival rates were 89.9, 84.7, and 70.9%, in the LAH group, and 89.8, 68.0, and 63.1% in the OAH group, respectively (p = 0.255). The 1-, 3-, and 5-year disease-free survival rates were 79.5, 58.0, and 42.5%, in the LAH group, and 72.4, 56.1, and 50.4% in the OAH group, respectively (p = 0.980).

Conclusions

Through gradual introduction of LAH, we obtained comparable results to those achieved with OAH. LAH can be a feasible surgical treatment for primary HCC, with good oncological outcomes.

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References

  1. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  PubMed  Google Scholar 

  2. Takayama T, Makuuchi M, Hirohashi S, Sakamoto M (1998) Early hepatocellular carcinoma as an entity with a high cure rate of surgical cure. Hepatology 28:1241–1246

    CAS  Article  PubMed  Google Scholar 

  3. 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 242:252–259

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kobayashi A, Miyagawa S, Miwa S, Nakata T (2008) Prognostic impact of anatomical resection on early and late intrahepatic recurrence in patients with hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 15:515–521

    Article  PubMed  Google Scholar 

  5. Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Ikai I, Kudo M, Kojiro M, Makuuchi M, Monden M, Matsuyama Y, Nakanuma Y, Takayasu K, Liver Cancer Study Group of Japan (2008) Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery 143:469–475

    Article  Google Scholar 

  6. Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Matsushita M, Todo S (2010) The impact of anatomical resection for hepatocellular carcinoma that meets Milan criteria. J Surg Oncol 101:54–60

    Article  PubMed  Google Scholar 

  7. Kudo A, Tanaka S, Ban D, Matsumura S, Irie T, Nakamura N, Arii S (2014) Anatomical resection reduces the recurrence of solitary hepatocellular carcinoma ≤5 cm without macrovascular invasion. Am J Surg 207:863–869

    Article  PubMed  Google Scholar 

  8. 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 189:190–194

    Article  PubMed  Google Scholar 

  9. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2804 patients. Ann Surg 250:931–941

    Google Scholar 

  10. Soubrane O, Goumard C, Laurent A, Tranchart H, Truant S, Gayet B, Salloum C, Luc G, Dokmak S, Piardi T, Cherqui D, Dagher I, Boleslawski E, Vibert E, Cunha AS, Belghiti J, Pessaux P, Boelle PY, Scatton O (2014) Laparoscopic resection of hepatocellular carcinoma: a French survey in 351 patients. HPB 16:357–365

    Article  PubMed  Google Scholar 

  11. Lee KF, Chong CN, Wong J, Cheung YS, Wong J, Lai P (2011) Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis. World J Surg 35:2268–2274

    Article  PubMed  Google Scholar 

  12. Truant S, Bouras AF, Hebbar M, Boleslawski E, Fromont G, Dharancy S, Leteutre E, Zerbib P, Pruvot FR (2011) Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surg Endosc 25:3668–3677

    CAS  Article  PubMed  Google Scholar 

  13. Kim H, Suh KS, Lee KW, Yi NJ, Hong G, Suh SW, Yoo T, Park MS, Choi YR, Lee HW (2014) Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case-controlled study with propensity score matching. Surg Endosc 28:950–960

    Article  PubMed  Google Scholar 

  14. Fancellu A, Rosman AS, Sanna V, Nigri GR, Zorcolo L, Pisano M, Melis M (2011) Meta-analysis of trials comparing minimally-invasive and open liver resections for hepatocellular carcinoma. J Surg Res 171:e33–e45

    Article  PubMed  Google Scholar 

  15. Li N, Wu YR, Wu B, Lu MQ (2012) Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: a meta-analysis. Hepatol Res 42:51–59

    Article  PubMed  Google Scholar 

  16. Yin Z, Fan X, Ye H, Yin D, Wang J (2013) Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol 20:1203–1215

    Article  PubMed  Google Scholar 

  17. Honda G, Kurata M, Tsuruta K (2008) Approach for systematic resection of the liver antero-superior area: exposing Glissonean pedicles by prior dissection of the major hepatic fissure. J Am Coll Surg 207:e1–e4

    Article  PubMed  Google Scholar 

  18. Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, Matsumoto H, Nakano D, Takahashi K (2013) Totally laparoscopic hepatectomy exposing the major vessels. J Hepatobiliary Pancreat Sci 20:435–440

    Article  PubMed  Google Scholar 

  19. Honda G, Kurata M, Okuda Y, Kobayashi S, Sakamoto K (2014) Totally laparoscopic hepatectomy exposing the vessels around the tumor intended to secure the surgical margin. Surg Endosc 28:1331–1332

    Article  PubMed  Google Scholar 

  20. Honda G, Kurata M, Okuda Y, Kobayashi S, Sakamoto K, Takahashi K (2014) Totally laparoscopic anatomical hepatectomy exposing the major hepatic veins from the root side: a case of the right anterior sectorectomy (with video). J Gastrointest Surg 18:1379–1380

    Article  PubMed  PubMed Central  Google Scholar 

  21. Okuda Y, Honda G, Kurata M, Kobayashi S (2013) A useful and convenient procedure for intermittent vascular occlusion in laparoscopic hepatectomy. Asian J Endosc Surg 6:100–103

    Article  PubMed  Google Scholar 

  22. Okuda Y, Honda G, Kurata M, Kobayashi S, Sakamoto K (2014) Dorsal approach to the middle hepatic vein in laparoscopic left hemihepatectomy. J Am Coll Surg 219:e1–e4

    Article  PubMed  Google Scholar 

  23. Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, Kawasaki S (1993) Surgery for small liver cancers. Semin Surg Oncol 9:298–304

    CAS  Article  PubMed  Google Scholar 

  24. Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau WY, Makuuchi M, Strong RW (2000) The Brisbane 2000 terminology of liver anatomy and resections. HBP 2:333–339

    Google Scholar 

  25. Kobayashi S, Honda G, Kurata M, Tadano S, Sakamoto K, Okuda Y (2016) An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg 263:1159–1163

    Article  PubMed  Google Scholar 

  26. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  27. Liver Cancer Study Group of Japan (2010) General rules for the clinical and pathological study of primary liver cancer, 3rd edn. Kanehara, Tokyo

    Google Scholar 

  28. Takayama T, Sekine T, Makuuchi M, Yamasaki S, Kosuge T, Yamamoto J, Shimada K, Sakamoto M, Hirohashi S, Ohashi Y, Kakizoe T (2000) Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomized trial. Lancet 356:802–807

    CAS  Article  PubMed  Google Scholar 

  29. Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795

    CAS  Article  PubMed  Google Scholar 

  30. Takenaka K, Kawahara N, Yamamoto K, Kajiyama K, Maeda T, Itasaka H, Shirabe K, Nishizaki T, Yanaga K, Sugimachi K (1996) Results of 280 liver resections for hepatocellular carcinoma. Arch Surg 131:71–76

    CAS  Article  PubMed  Google Scholar 

  31. Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Makuuchi M (1996) Recurrence of hepatocellular carcinoma after surgery. Br J Surg 83:1219–1222

    CAS  Article  PubMed  Google Scholar 

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Disclosures

Goro Honda has received lecture fees from Johnson & Johnson and Covidien. Tomoki Ryu, Masanao Kurata, Shin Kobayashi, Katsunori Sakamoto, and Masahiko Honjo have no conflicts of interest or financial ties to disclose.

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Affiliations

  1. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Tomoki Ryu, Goro Honda, Masanao Kurata, Shin Kobayashi, Katsunori Sakamoto & Masahiko Honjo

  2. Department of Hepato-biliary-Pancreatic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Tomoki Ryu

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  1. Tomoki Ryu
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  2. Goro Honda
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  3. Masanao Kurata
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  4. Shin Kobayashi
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  5. Katsunori Sakamoto
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Correspondence to Goro Honda.

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Ryu, T., Honda, G., Kurata, M. et al. Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center. Surg Endosc 32, 790–798 (2018). https://doi.org/10.1007/s00464-017-5745-0

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  • DOI: https://doi.org/10.1007/s00464-017-5745-0

Keywords

  • Hepatocellular carcinoma
  • Anatomical hepatectomy
  • Laparoscopic hepatectomy