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Perioperative and long-term survival outcomes of laparoscopic versus laparotomic hepatectomy for BCLC stages 0–A hepatocellular carcinoma patients associated with or without microvascular invasion: a multicenter, propensity score matching analysis

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Abstract

Purpose

To analyze the long-term oncological outcomes of Barcelona Clinic Liver Cancer (BCLC) stages 0–A hepatocellular carcinoma (HCC) patients associated with or without microvascular invasion (MVI) treated with laparoscopic versus laparotomic liver resection.

Methods

Clinicopathological data of HCC patients with BCLC stages 0–A from four medical centers were retrospectively reviewed. The survival outcomes of patients who underwent laparoscopic hepatectomy were compared with those who underwent laparotomic hepatectomy. Subgroup analyses in terms of MVI were further performed to explore the effect of surgical approaches on the long-term survival outcomes. Propensity score matching (PSM) analysis was used to match patients between the laparoscopic and laparotomic resection groups in a 1:1 ratio.

Results

495 HCC patients at BCLC stages 0–A were enrolled, including 243 in the laparoscopic resection group and 252 in the laparotomic resection group. Laparoscopic resection group had a shorter operation time, less blood loss, a lower frequency of blood transfusion and postoperative complication rates. The laparoscopic resection group had a significantly better overall survival (OS) and recurrence-free survival (RFS) than the laparotomic resection group before and after PSM. Subgroup analysis demonstrated that OS and RFS of patients without MVI were remarkably better in the laparoscopic resection group compared with the laparotomic resection group. However, no significant differences in OS and RFS between the two groups were found in patients with MVI after PSM.

Conclusions

Pure laparoscopic hepatectomy for patients with BCLC stages 0–A HCC can be performed safely with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers, regardless of the presence of MVI.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by Meng Chao Talent Training Program (EHBH2019YC112) and National Natural Science Foundation of China (82172846).

Funding

Meng Chao Talent Training Program (EHBH2019YC112); National Natural Science Foundation of China (82172846).

Author information

Author notes

  1. Shi-Ye Yang, Mao-Lin Yan, Yun-Fei Duan, Jin-Kai Feng and Jia-Zhou Ye have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China

    Shi-Ye Yang, Jin-Kai Feng, Yan-Jun Xiang, Zong-Han Liu, Lei Guo, Jie Xue, Shu-Qun Cheng & Wei-Xing Guo

  2. Department of Hepatobiliary and Pancreatic Surgery, Fujian Provincial Hospital, The Shengli Clinical Medical College of Fujian Medical University, Fujian, China

    Mao-Lin Yan

  3. Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University (Changzhou People’s Hospital), Jiangsu, China

    Yun-Fei Duan

  4. Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Guangxi, China

    Jia-Zhou Ye

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  1. Shi-Ye Yang
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Contributions

Conception and design: W-XG, S-QC, S-YY, M-LY, Y-FD, J-KF, J-ZY; Administrative support: W-XG, S-QC; Provision of study materials or patients: W-XG, S-QC, M-LY, YD, J-ZY; Collection and assembly of data: S-YY, LG, JX; Data analysis and interpretation: S-YY, J-KF, Y-JX, Z-HL; Statistical analysis: S-YY, J-KF, Y-JX, Z-HL; Manuscript writing: all authors; Final approval of manuscript: all authors.

Corresponding authors

Correspondence to Shu-Qun Cheng or Wei-Xing Guo.

Ethics declarations

Conflict of interest

Shi-Ye Yang, Mao-Lin Yan, Yun-Fei Duan, Jin-Kai Feng, Jia-Zhou Ye, Yan-Jun Xiang, Zong-Han Liu, Lei Guo, Jie Xue, Shu-Qun Cheng and Wei-Xing Guo have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethics approval and consent to participate (ethics)

All procedures performed in this study involving human participants were approved by the Institutional Ethics Review Board of the Eastern Hepatobiliary Surgery Hospital, Fujian Provincial Hospital, The Third Affiliated Hospital of Soochow University, and Affiliated Tumor Hospital of Guangxi Medical University. This study was in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent for study participation was obtained from all the patients.

Consent to publish (ethics)

All authors confirm that the work described has not been published before and is not under consideration for publication elsewhere. All authors have seen and gave consent to the publication of this study. The publication of this work has been approved by the responsible authorities at the institution where the work is carried out.

Animal research (ethics)

Not applicable.

Clinical trials registration

Not applicable because this is a retrospective observational study.

Synopsis

For hepatocellular carcinoma (HCC) patients at BCLC stages 0–A with or without microvascular invasion (MVI), laparoscopic liver resection may be a safe and feasible alternative to laparotomic liver resection.

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Yang, SY., Yan, ML., Duan, YF. et al. Perioperative and long-term survival outcomes of laparoscopic versus laparotomic hepatectomy for BCLC stages 0–A hepatocellular carcinoma patients associated with or without microvascular invasion: a multicenter, propensity score matching analysis. Hepatol Int 16, 892–905 (2022). https://doi.org/10.1007/s12072-022-10353-4

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  • DOI: https://doi.org/10.1007/s12072-022-10353-4

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