Laparoscopic Hepatic Resection for Hepatocellular Carcinoma: Comparative Analysis of Short and Long Term Results

Satoru Imura, MD, Mitsuo Shimada, MD PhD, Tohru Utsunomiya, MD PhD, Yuji Morine, MD, Tetsuya Ikemoto, MD, Hiroki Mori, MD, Jun Hanaoka, MD, Mami Kanamoto, MD, Koji Sugimoto, MD, Hidenori Miyake, MD PhD. Tokushima University

INTRODUCTION: With progress of surgical technique and devices, laparoscopic hepatectomy (LH) became a realizable option for patients with hepatocellular carcinoma (HCC). However, the feasibility of LH for HCC should be guaranteed also oncologically. Herein, we evaluate the short and long term outcome of LH compared with open hepatectomy (OH) for HCC patients by matched pair analysis.
METHODS AND PROCEDURES: From January 2007, 23 consecutive HCC patients who underwent LH were compared in a retrospective analysis with a historic group of 23 patients who underwent OH. The two groups were well matched for age, gender, tumor location and size, type of hepatic resection, and severity of cirrhosis. The selection criteria of HCC for both groups specified a small (size <6 cm), in the left or peripheral right segments of the liver (Couinaud’s segment: II-VI, VIII). The patients less than 80-year and without severe cirrhosis were included in this study.
RESULTS: The mean age was similar in both groups (LH: 64yr [40-77], OH: 62yr [49-78]). All patients were Child-Pugh A, except 1 patient in LH group. The mean operative time was similar in both groups (LH: 288min [198-411], OH: 322min [159-470]). The mean blood loss in the LH group was significantly less than OH group (149ml [28-429] vs 244ml [45-620], p<0.05). The mean hospital stay in the LH group was significantly shorter than OH group (15days vs. 22days, p<0.05). There was no significant difference in the incidence of postoperative complication. Critical complication was not observed except 1 case of gas embolism in the LH group (emergent conversion to laparotomy). Overall survival rate was 96% at 1-year, 85% at 3-year in LH group and 91% at 1-year, 80% at 3-year in OH group. Disease-free survival rate was 77% at 1-year, 71% at 3-year in LH group and 62% at 1-year, 58% at 3-year in OH group. There was no significant difference in overall and disease-free survival between the two groups.
CONCLUSION: LH is safe and feasible option for selected HCC patients. The short and long term outcome of LH is also considered to be acceptable.

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