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Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Case Controlled Study with Propensity Score Matching

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Abstract

Background

Several studies have suggested that laparoscopic liver resection (LLR) is associated with fewer postoperative complications than open liver resection (OLR) for hepatocellular carcinoma (HCC). However, this issue remains controversial since the data may have been attributable to an imbalance in patients’ background.

Methods

We retrospectively analyzed 290 hepatectomies for HCC undertaken between 2011 and 2019. Liver resection difficulty was based on the 3 levels of the Institut Mutualiste Montsouris classification. Resection ratio was calculated using computed tomography volumetry. Patient characteristics were compared between the LLR and OLR groups. Propensity score matching (PSM) was adopted to adjust the imbalance between the cohorts, and the incidence of postoperative complications was compared.

Results

The difficulty and resection ratio were significantly lower in LLR (n = 112) than in OLR (n = 178) (difficulty grade I/II/III: 84/10/18 vs. 43/39/96, p < 0.001; resection ratio: 11.4 ± 12.7 vs. 22.7 ± 17.2%, p < 0.001). The incidence of postoperative complications (Clavien–Dindo grade III or more) was lower in LLR (2.7% vs. 21.9%, p < 0.001), which was mainly attributable to fewer incidences of ascites and pleural effusion. PSM generated 68 well-matched patients in each group. The lower incidence of postoperative complications in LLR was also maintained in the PSM cohort (2.9% vs. 16.2%, p = 0.017). On multivariate analysis, LLR was the independent predictor of postoperative complications (OR 0.184, 95% CI 0.051–0.672, p = 0.010).

Conclusion

The present study demonstrated that a laparoscopic approach reduces the incidence of postoperative complications in liver resection for HCC.

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Acknowledgements

We thank H. Nikki March, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Hepato Biliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, 54 Kawaharacho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Yusuke Uemoto, Kojiro Taura, Takahiro Nishio, Yusuke Kimura, Nguyen Hai Nam, Kenji Yoshino, Tomoaki Yoh, Yukinori Koyama, Satoshi Ogiso, Ken Fukumitsu, Takamichi Ishii & Satoru Seo

  2. Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan

    Shinji Uemoto

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  1. Yusuke Uemoto
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  2. Kojiro Taura
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Corresponding author

Correspondence to Kojiro Taura.

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Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose as described by this article.

Ethical approval

This research was approved by the Institutional Review Board at Kyoto University Graduate School of Medicine (approval code: R1579).

Informed consent

The requirement for obtaining written informed consent from each patient was waived because of the retrospective study design.

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Our study is registered with University Hospital Medical Information Network (UMIN, https://www.umin.ac.jp). The registration number is UMIN000041288 (https://upload.umin.ac.jp/cgi-openbin/ctr/ctr_view.cgi?recptno=R000047142).

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Uemoto, Y., Taura, K., Nishio, T. et al. Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Case Controlled Study with Propensity Score Matching. World J Surg 45, 2572–2580 (2021). https://doi.org/10.1007/s00268-021-06115-2

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  • DOI: https://doi.org/10.1007/s00268-021-06115-2

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