Annals of Surgical Oncology

, Volume 16, Issue 6, pp 1572–1577 | Cite as

Outcome for Patients Treated with Laparoscopic Versus Open Resection of Hepatocellular Carcinoma: Case-Matched Analysis

  • U. Sarpel
  • M. M. Hefti
  • J. P. Wisnievsky
  • S. Roayaie
  • M. E. Schwartz
  • D. M. Labow
Hepatobiliary and Pancreatic Tumors

Abstract

Introduction

This is a case-matched analysis of patients undergoing laparoscopic versus open hepatectomy for hepatocellular carcinoma (HCC), with specific regard to margin status and survival.

Methods

Laparoscopic cases were matched with open controls by cirrhosis and tumor size (within 10%). Data were evaluated by logistic regression using the generalized estimating equation method. Mixed linear regression models were used to assess operative duration in the groups. Overall and disease-free survival were compared using a Cox proportional frailty model.

Results

Twenty laparoscopic cases were matched to 56 open resections. Thirty patients (39%) developed recurrence and 13 patients (17%) died, including one (1.3%) death within 30 days. There were no significant differences in age, gender, cirrhosis or tumor size. Paired univariate and multivariate analyses showed cases of laparoscopic resection had similar rates of transfusion and positive margins compared with open resection. Operative duration was similar in laparoscopic (mean 161 ± 37 min) and open (mean 165 ± 53 min) groups. The adjusted odds of length of stay ≥ 6 days was significantly lower in patients with laparoscopic resection [odds ratio (OR) = 0.07, 95% confidence interval (CI) = 0.02–0.27]. Both unadjusted and adjusted analyses showed no significant association between type of resection and overall or disease-free survival.

Discussion

Neither margin status, nor recurrence, nor survival was significantly different between the two cohorts. Laparoscopic resection for malignancy is safe, with a similar operative time as open hepatectomy. If tumor location is amenable, laparoscopic resection for HCC is a reasonable alternative to open resection with the added benefits of improved cosmesis and sooner discharge home.

References

  1. 1.
    Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg. 2005;189:190–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Koffron AJ, Auffenberg G, Kung R, Abecassis M. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg. 2007;246:385–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Laurence JM, Lam VWT, Langcake ME, Hollands MJ, Crawford MD, Pleass HCC. Laparoscopic hepatectomy: a systematic review. ANZ J Surg. 2007;77:948–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Laurent A, Cherqui D, Lesurtel M, Brunetti F, Tayar C, Fagniez PL. Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg. 2003;138:763–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Mala T, Edwin B, Gladhaug I, Fosse E, Søreide O, Bergan A, et al. A comparative study of the short-term outcome following open and laparoscopic liver resection of colorectal metastases. Surg Endosc. 2002;16:1059–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Morino M, Morra I, Rosso E, Miglietta C, Garrone C. Laparoscopic vs open hepatic resection: a comparative study. Surg Endosc. 2003;17:1914–18.PubMedCrossRefGoogle Scholar
  7. 7.
    Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, et al. Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery. 2007;141:203–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Chang S, Laurent A, Tayar C, Karoui M, Cherqui D. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg. 2007;94:58–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, et al. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg. 2006;243(4):499–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Lesurtel M, Cherqui D, Laurent A, Tayar C, Fagniez PL. Laparoscopic versus open left lateral hepatic lobectomy: a case–control study. J Am Coll Surg. 2002;196(2):236-42.CrossRefGoogle Scholar
  11. 11.
    Nguyen KT, Gamblin TC, Geller DA. Laparoscopic liver resection for cancer. Future Oncol. 2008;4(5):661–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Chen HY, Juan CC, Ker CG. Laparoscopic liver surgery for patients with hepatocellular carcinoma. Ann Surg Oncol. 2008;15(3):800–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, et al. Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc. 2008;22(2):372-8.PubMedCrossRefGoogle Scholar
  14. 14.
    Liang KY, Zeger SL. Longitudinal data analyses using generalized linear models. Biometrika. 1988;73:13–22.CrossRefGoogle Scholar
  15. 15.
    Hougaard P Frailty models for survival data. Lifetime Data Anal. 1995;1:255–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Rau HG, Buttler E, Meyer G, Schardey HM, Schildberg FW. Laparoscopic liver resection compared with conventional partial hepatectomy—a prospective analysis. Hepatogastroenterology. 1998;45(24):2333–8.PubMedGoogle Scholar
  17. 17.
    Farges O, Jagot P, Kirstetter P, Marty J, Belghiti J. Prospective assessment of the safety and benefit of laparoscopic liver resections. J Hepatobiliary Pancreat Surg. 2002;9(2):242-8.PubMedCrossRefGoogle Scholar
  18. 18.
    Kamiyama T, Kurauchi N, Nakagawa T, et al. Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system. J Hepatobiliary Pancreat Surg. 2005; 12: 49–54.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • U. Sarpel
    • 1
  • M. M. Hefti
    • 2
  • J. P. Wisnievsky
    • 3
  • S. Roayaie
    • 4
  • M. E. Schwartz
    • 4
  • D. M. Labow
    • 4
  1. 1.Department of SurgeryNew York University Medical CenterNew YorkUSA
  2. 2.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  3. 3.Department of MedicineMount Sinai Medical CenterNew YorkUSA
  4. 4.Department of SurgeryMount Sinai Medical CenterNew YorkUSA

Personalised recommendations