So Hyun Kang, Woohyung Lee, Youngrok Choi, Ho-Seong Han, Yoo-Seok Yoon, Jai Young Cho, Kilhwan Kim, In-Gun Hyun, Sunjong Han. Seoul National University Bundang Hospital
Introduction: Combined hepatocellular carcinoma and cholagiocarcinoma (HCC-CCC) is a rare primary hepatic neoplasm with incidence reporting up to 3.5%. Liver resection is still the preferred method for curative treatment. With the advancement of minimally invasive techniques, laparoscopic liver resection (LLR) is now a possible option for patients with resectable HCC-CCC, yet there are no published studies that analyze the feasibility of LLR in HCC-CCC alone. This study aims to compare the long-term survival and postoperative complications of LLR with open liver resection (OLR) in HCC-CCC.
Methods: Patients who underwent liver resection for HCC-CCC from August 2004 to June 2015 were enrolled. Those who received palliative surgery, and those who underwent open conversion after laparoscopic surgery were excluded. Medical records of these patients were retrospectively reviewed. Primary endpoint was 3-year disease-free survival (DFS) and 3-year overall survival (OS), and secondary enpoints were 3-year disease-specific survival, 1-year OS, 1-year DFS, operative outcome, and postoperative complications. Kaplan-Meier survival analysis was performed to compare survival.
Results: After exclusion, 13 patients were enrolled in the OLR group and 13 patients in the LLR group. There was no difference in age, gender, type of liver surgery (major or minor hepatectomy), tumor location (favorable or unfavorable), liver function, size of largest tumor, and pathologic stanging. Mean operation time for OLR was 314.2 ± 135.1 minutes and for LLR it was 337.3 ± 155.9 minutes with no statistical significance (p=0.690). There was also no statistical difference in estimated blood loss (1173.1 ± 1459.7 vs 453.8 ± 271.9, p=0.105). The 3-year disease free survival for the OLR group was 38.5% while the LLR group was slightly higher with 53.8%, but there was no statistical difference (p=0.828). The 3-year overall survival was the same in both groups (69.2%). The 3-year disease-specific survival was also analyzed, and the OLR group was higher with 76.9% to 73.1% for the LLR group, but there was also no statistical significance (p=0.591).
Conclusion: Laparoscopic liver resection for HCC-CCC is technically feasible showing similar long-term outcome with open liver resection. However, a large scale cohort study is still needed to provide better evidence, and until then, careful patient selection must be taken place.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94096
Program Number: P233
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster