Laparoscopic hepatectomy could be the first choice of treatment in selected patients with hepatocellular carcinoma

M Shimada, MD, FACS, S Iwahashi, MD, S Yamada, MD, Y Saitoh, MD, M Kanamoto, MD, Y Arakawa, MD, T Ikemoto, MD, Y Morine, MD, S Imura, MD, T Utsunomia, MD, H Miyake, MD

Department of Surgery, The University of Tokushima

Introduction: Laparoscopic hepatectomy (Lap-Hx) has been established as an important treatment choice for liver tumors, judging from short-term outcome. However, role of Lap-Hx including long-term outcomes remains controversial for hepatocellular carcinoma (HCC). The aim of this study was to clarify usefulness of Lap-Hx for HCC.

Patients and Methods: <Indication> In principle, HCC of more than 10 cm in diameter, with macroscopic vascular invasion, very close to major vessels, is contraindicated for Lap-Hx including a hybrid method. <Patients> Thirty patients with HCC who underwent Lap-Hx were enrolled in this study. Age ranged from 40 to 77 with a median of 63.3, and male:female was 19:11. Tumors were located in the entire liver, and tumor size ranged from 1 cm to 8 cm (median 3.3 cm) in diameter. Operative procedures consisted of right Hx in 1, left Hx in 5, medial segmentectomy in 1, posterior segmentectomy in 1, left lateral segmentectomy in 6, subsegmentectomy in 5, and partial Hx in 11. <Methods> The patients were compared with 30 matched patients who underwent open Hx (Open-Hx), in which the following parameters were matched; liver function, tumor size, tumor location and operative procedure. Both short- and long-term outcomes in Lap-Hx were compared with those in Open-Hx.

Results: No difference was observed between the two groups, in age, gender, viral status, Child-Pugh status, ICGR15, tumor size, and operative procedures. <Short-term outcome> Operative time (291 ± 69 min.) in Lap-Hx was similar to that in Open-Hx (317 ± 76 min.). Blood loss (143 ± 116 ml) in Lap-Hx was smaller than that in Open-Hx (220 ± 166 ml), and hospital stay (15.5 days) in Lap-Hx was shorter than that in Open-Hx (21.4 days). No difference was observed in incidence and kinds of postoperative complications between the two groups. <Long-term outcome> 5-year disease-free survival rate in Lap-Hx tended to be higher than that in Open-Hx (71 % and 52 %), although no difference was observed in 5-year survival rate between the two groups.

Conclusions: Lap-Hx could be the first choice of treatment in selected patients with HCC from the viewpoint of short-and long-term outcomes.