Advertisement

Surgical Endoscopy

, Volume 33, Issue 4, pp 1131–1139 | Cite as

Long-term and short-term surgical outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma: might laparoscopic approach be better in early HCC?

  • Kuei-Yen Tsai
  • Hsin-An Chen
  • Wan-Yu Wang
  • Ming-Te HuangEmail author
Article
  • 209 Downloads

Abstract

Background

This retrospective study compared the short- and long-term outcomes of laparoscopic liver resection (LLR) and open liver resection (OLR) and identified patients who might gain more benefits from LLR.

Methods

The demographic and perioperative data, short-term surgical outcomes, and long-term oncological results of all 313 patients who received elective liver resection for hepatocellular carcinoma (HCC) between January 2010 and June 2017 were analyzed. The patients were then divided into stage-specific subgroups according to the TNM staging system for comparison.

Results

LLR was performed in 153 patients and OLR in 160 patients. LLR is associated with less blood loss (p < 0.001), shorter surgical time (p = 0.001), shorter length of hospital stay (p < 0.001), and lower morbidity rate (p = 0.034). The 5-year overall survival (OS) rates in the LLR group were higher than those in the OLR group (78.1 vs. 57.6%; p = 0.002). Stage-specific subgroup analysis revealed similar 5-year OS in the two groups (stage I: 82.8 vs. 82.6%, p = 0.845; stage II: 80.3 vs. 69.2%, p = 0.638; stage III: 55.6 vs. 34.8%, p = 0.681), as did the 5-year recurrence-free survival. Moreover, the short-term outcomes were better in the LLR group in terms of surgical time, blood loss, and length of hospital stay, and these benefits attenuated with advancing tumor stage.

Conclusions

LLR for HCC is a safe and feasible procedure that does not compromise long-term oncological outcomes. In early tumor stages, LLR might be better in terms of short-term surgical outcomes.

Keywords

Laparoscopic hepatectomy Overall survival Recurrence-free survival Stage-specific prognosis 

Notes

Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Compliance with ethical standards

Disclosures

Drs. Kuei-Yen Tsai, Hsin-An Chen, Wan-Yu Wang, and Ming-Te Huang have no conflict of interest or financial ties to disclose.

References

  1. 1.
    Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC (2006) Predictive indices of morbidity and mortality after liver resection. Ann Surg 243:373CrossRefGoogle Scholar
  2. 2.
    Jin S, Fu Q, Wuyun G, Wuyun T (2013) Management of post-hepatectomy complications. World J Gastroenterol 19:7983CrossRefGoogle Scholar
  3. 3.
    Yoon Y-S, Han H-S, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637CrossRefGoogle Scholar
  4. 4.
    Cardinal J, Reddy S, Tsung A, Marsh J, Geller D (2013) Laparoscopic major hepatectomy: pure laparoscopic approach versus hand-assisted technique. J Hepato-Biliary-Pancreat Sci 20:114–119CrossRefGoogle Scholar
  5. 5.
    Jiang B, Yan X, Zhang JH (2018) Meta-analysis of laparoscopic versus open liver resection for hepatocellular carcinoma. Hepatol Res: Off J Jpn Soc Hepatol 48:635–663CrossRefGoogle Scholar
  6. 6.
    Aldrighetti L, Guzzetti E, Pulitano C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefGoogle Scholar
  7. 7.
    Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L (2017) Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 31:4790–4798CrossRefGoogle Scholar
  8. 8.
    Buell JF, Cherqui D, Geller DA, O’rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS (2009) The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 250:825–830CrossRefGoogle Scholar
  9. 9.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 (discussion 828–829)CrossRefGoogle Scholar
  10. 10.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  11. 11.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  12. 12.
    Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (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 22:721–727CrossRefGoogle Scholar
  13. 13.
    Kim H, Suh KS, Lee KW, Yi NJ, Hong G, Suh SW, Yoo T, Park MS, Choi Y, 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 28:950–960CrossRefGoogle Scholar
  14. 14.
    Kobayashi T (2015) Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience. Ann Surg 262:e20CrossRefGoogle Scholar
  15. 15.
    El-Gendi A, El-Shafei M, El-Gendi S, Shawky A (2017) Laparoscopic versus open hepatic resection for solitary hepatocellular carcinoma less than 5 cm in cirrhotic patients: a randomized controlled study. J Laparoendosc Adv Surg Tech A 28:302–310CrossRefGoogle Scholar
  16. 16.
    Lee JJ, Conneely JB, Smoot RL, Gallinger S, Greig PD, Moulton CA, Wei A, McGilvray I, Cleary SP (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis. HPB 17:304–310CrossRefGoogle Scholar
  17. 17.
    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650CrossRefGoogle Scholar
  18. 18.
    Xu HW, Li HY, Liu F, Wei YG, Li B (2017) Laparoscopic versus open liver resection for lesions adjacent to major vessels: a propensity score matched analysis. J Laparoendosc Adv Surg Tech A 27:1002–1008CrossRefGoogle Scholar
  19. 19.
    Yoon SY, Kim KH, Jung DH, Yu A, Lee SG (2015) Oncological and surgical results of laparoscopic versus open liver resection for HCC less than 5 cm: case-matched analysis. Surg Endosc 29:2628–2634CrossRefGoogle Scholar
  20. 20.
    Xu HW, Liu F, Li HY, Wei YG, Li B (2018) Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score-matched analysis. Surg Endosc 32:712–719CrossRefGoogle Scholar
  21. 21.
    Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscara C, Scotti M, Romito R, Mariani L, Mazzaferro V (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880CrossRefGoogle Scholar
  22. 22.
    Badawy A, Seo S, Toda R, Fuji H, Fukumitsu K, Ishii T, Taura K, Kaido T, Uemoto S (2017) A propensity score-based analysis of laparoscopic liver resection for liver malignancies in elderly patients. J Investig Surg: Off J Acad Surg Res.  https://doi.org/10.1080/08941939.2017.1373170 Google Scholar
  23. 23.
    Ahn KS, Kang KJ, Kim YH, Kim TS, 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 24:872–877CrossRefGoogle Scholar
  24. 24.
    Cheung TT, Dai WC, Tsang SH, Chan AC, Chok KS, Chan SC, Lo CM (2016) Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a Single Center. Ann Surg 264:612–620CrossRefGoogle Scholar
  25. 25.
    Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, Jung DH, Park GC, Ahn CS, Moon DB, Ha TY, Song GW, Hwang S, Lee SG (2017) Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann Surg 265:856–863CrossRefGoogle Scholar
  26. 26.
    Piardi T, Sommacale D, Baumert T, Mutter D, Marescaux J, Pessaux P (2014) Laparoscopic resection for hepatocellular carcinoma: comparison between Middle Eastern and Western experience. Hepatobiliary Surg Nutr 3:60–72Google Scholar
  27. 27.
    Zhou YM, Shao WY, Zhao YF, Xu DH, Li B (2011) Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma. Digest Dis Sci 56:1937–1943CrossRefGoogle Scholar
  28. 28.
    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629Google Scholar
  29. 29.
    Tanaka S, Kubo S, Kanazawa A, Takeda Y, Hirokawa F, Nitta H, Nakajima T, Kaizu T, Kaneko H, Wakabayashi G (2017) Validation of a difficulty scoring system for laparoscopic liver resection: a multicenter analysis by the Endoscopic Liver Surgery Study Group in Japan. J Am Coll Surg 225:249–258, e241CrossRefGoogle Scholar
  30. 30.
    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 Hepato-Biliary-Pancreat Sci 15:515–521CrossRefGoogle Scholar
  31. 31.
    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 242:252CrossRefGoogle Scholar
  32. 32.
    Li SQ, Huang T, Shen SL, Hua YP, Hu WJ, Kuang M, Peng BG, Liang LJ (2017) Anatomical versus non-anatomical liver resection for hepatocellular carcinoma exceeding Milan criteria. BJS 104:118–127CrossRefGoogle Scholar
  33. 33.
    Marubashi S, Gotoh K, Akita H, Takahashi H, Ito Y, Yano M, Ishikawa O, Sakon M (2015) Anatomical versus non-anatomical resection for hepatocellular carcinoma. BJS 102:776–784CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryTaipei Medical University Shuang Ho HospitalNew Taipei CityTaiwan, Republic of China
  2. 2.Division of General Surgery, Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan, Republic of China

Personalised recommendations