Oncologic Safety of Laparoscopic Hepatectomy Versus Open Hepatectomy in Hepatocellular Carcinoma

Stephen Ky Chang, FRCS, Chee Wei Tay, MRCSEd, Wah Wah Hlaing, Ms, Iyer Shridhar Ganpathi, FRCS, Victor Tw Lee, FRCS, Krishnakumar Madhavan, FRCS. National University Health System, Singapore


Laparoscopic hepatectomy (LH) has increasingly become more established as a curative option for hepatocellular carcinoma (HCC), however, oncologic issues such as ability to achieve adequate margins, tumour size and location, port side recurrence and other peri-operative and post-operative issues remains poorly studied.

This paper aims to study a university hospital experience of LH in HCC patients, compare the oncologic outcomes of patients who underwent open hepatectomy (OH), address oncologic issues in LH, give suggestions of surgical issues among HCC patients who underwent LH and also aim to identify risk factors of HCC recurrence.

30 consecutive patients who underwent LH for HCC from August 2006 to August 2010 in a university hospital were retrospectively studied. These 30 patients who underwent LH were matched with 30 patients who underwent OH for HCC with similar age, extend of resection and cirrhosis status for comparisons.

Patient’s demographic data such as age, sex, risk factor of HCC, Child’s status, presence of cirrhosis were recorded. Oncologic data such as tumour size and location, resection margin in millimeter (mm), tumour characteristic, presence of recurrence, time to recurrence, follow up and survival were studied. Surgical data such as surgical approach (laparoscopic/hand-assisted/single-portal), operative time, and length of hospitalization were recorded.

All 60 patients from both groups will be divided into patients with recurrence and without recurrence; all parameters were examined to identify risk factors of HCC recurrence in general.

Continuous variables were compared using the Mann–Whitney U test and categorical variables were compared with chi-square test.

There is no statistically significant difference in mean operative time between LH and OH (266 vs 295 minutes). Patients who underwent LH had 5 days shorter in mean length of (6 vs 11, p=0.001). No statistical difference in 30 days mortality rate between 2 groups.

Mean tumour size was similar between 2 groups (40.6 vs 45mm). Negative resection margins were achieved in 97% in both groups, mean resection margins were 9.9 vs 8.2 mm (p=0.24). No statistically significant difference in histological features between the 2 groups. 8 (27%) patients in LH group versus 13 (43%) patients in OH group had recurrence of HCC, with the mean time to recurrence of 22 vs 33 months.

38% patients from both groups developed recurrence. In the sub-analysis between recurrence and non-recurrence group, mean tumour size was statistically bigger in recurrence group (54 vs 35.6 mm, p=0.002). Resection margins were also statistically smaller in recurrence group, 4.6mm vs 11.8mm (p=0.002). There is no statistical difference in recurrence between LH and OH group.

Laparoscopic hepatectomy is a feasible curative treatment option for HCC; it can be performed to remove HCC bigger than 5cm and certain centrally located tumours without any significant peri and post-operative issues by experienced surgeons. Adequate resection margin were achieved in 97% of the patients underwent LH, recurrence rate was similar with OH group. Tumour size and resection margin are the predictor of recurrence of HCC in both laparoscopic and open groups.

Session Number: SS03 – HPB (Hepatobiliary and Pancreas)
Program Number: S013

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