Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma: A Comparative Study

Ibrahim DAGHER, Giuseppe DI GIURO, Panagiotis LAINAS, Helene AGOSTINI, Alessio CARLONI, Dominique FRANCO
Department of General Surgery, Antoine Béclère Hospital, AP-HP, Clamart, F-92140, France; Univ Paris-Sud, Orsay, F-91405, France.

Objective of the study: Laparoscopic liver resection for hepatocarcinoma, especially in cirrhotic patients, has recently been developed and could reduce morbidity. However, it is limited to centers with experience in both laparoscopic liver surgery and the management of cirrhotic patients. Very few series were therefore reported. The aim of this study was to compare the postoperative results and the 3-year patient outcomes between laparoscopic (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC).
Methods and procedures: From 1999 to 2007, we performed 36 laparoscopic resections for HCC in selected patients. They were compared in a retrospective analysis with 36 patients who underwent open surgery for HCC selected from our liver resection database. The two groups were well matched for age, gender, ASA class, tumor size, type of liver resection and severity of liver disease. Child-Pugh class C and ASA class 3 were considered as non inclusion criteria. Chi-square or t-test were used to compare the 2 groups (respectively Fisher exact test and Mann-Whitney U test when the validity conditions were not verified).
Results: The mean operative duration was similar in both groups (LLR, 237 min; OLR, 227 min; p = 0.85). Blood loss was significantly lower in laparoscopic resections (LLR, 387 ml; OLR, 737 ml; p = 0.0006). However, the difference in transfusion rates was not statistically significant (LLR, 11.1%; OLR, 19.4%; p=0.51). There was no statistically significant difference in specific (LLR, 13.9%; OLR, 13.9%; p = 1.00) and general (LLR, 8.3%; OLR, 11.1%, p=1.00) postoperative complications. Mean hospital stay was significantly shorter for patients undergoing laparoscopy (6.7 vs. 9.5 days; p = 0.0009). The 1- and 3-year survival rates were not different for LLR and OLR.
Conclusions based on the results: This study shows that laparoscopic resection for HCC results in decreased blood loss and shorter hospital stay. The 1- and 3-year survival rates were not different for LLR and OLR.

Session: Podium Presentation

Program Number: S097

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