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Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis

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Abstract

Background

Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC).

Materials and Methods

From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival.

Results

The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6 days vs. 8 days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival.

Conclusion

LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.

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Acknowledgements

The authors would gratefully thank Mr. Philip Ip (Department of Surgery, The Chinese University of Hong Kong) for his excellent help with the data collection and analysis.

Funding

The present study receives no funding from any organization.

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Authors and Affiliations

  1. Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong

    Kelvin K. C. Ng, Charing C. N. Chong & Paul B. S. Lai

  2. Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong

    Kelvin K. C. Ng, Janet W. C. Kung, Hon-Ting Lok, Andrew K. Y. Fung, Charing C. N. Chong, Sunny Y. S. Cheung, Kit-Fai Lee, John Wong & Paul B. S. Lai

  3. Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong

    Kai-Chi Cheng & Kit-Man Ho

  4. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30 - 32 Ngan Shing Street, New Territories, Hong Kong

    Kelvin K. C. Ng

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  1. Kelvin K. C. Ng
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Correspondence to Kelvin K. C. Ng.

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Prof. Kelvin K.C. Ng, Dr. Kai-Chi Cheng, Dr. Janet W.C. Kung, Dr. Kit-Man Ho, Dr. Hon-Ting Lok, Dr. Andrew K.Y. Fung, Dr. Charing C.N. Chong, Dr. Sunny Y.S. Cheung, Dr. Kit-Fai Lee, Dr. John Wong, and Prof. Paul B.S. Lai have no conflicts of interest or financial ties to disclose.

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Ng, K.K.C., Cheng, KC., Kung, J.W.C. et al. Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis. Surg Endosc 38, 857–871 (2024). https://doi.org/10.1007/s00464-023-10634-5

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