Laparoscopic liver resection for hepatocellular carcinoma in Child-Pugh class B cirrhosis

Osamu Itano, MD, PhD, FACS, Masahiro Shinoda, MD, PhD, Minoru Kitago, MD, PhD, Yuta Abe, MD, PhD, Taizo Hibi, MD, PhD, Hiroshi Yagi, MD, PhD, Chisato Takagi, MD, Yuko Kitagawa, MD, PhD, FACS. Department of Surgery, Keio University School of Medicine

Background: There have been several reports confirming that laparoscopic liver resection for hepatocellular carcinoma (HCC) is safer and more feasible than open liver resection in patients with cirrhosis. However, the patients in most studies had mild cirrhosis and few reports have focused on patients with severe cirrhosis. Here we evaluated the feasibility of laparoscopic liver resection for HCC in patients with Child-Pugh class B cirrhosis.

Methods: We retrospectively reviewed the data of 70 patients who underwent partial hepatectomy or left lateral sectionectomy for HCC until December 2014 in our institution. The patients were divided into three groups according to liver function: Child-Pugh class B (Cirrhosis B), Child-Pugh class A cirrhosis (Cirrhosis A), and Child-Pugh class A non-cirrhosis (Non-cirrhosis). The perioperative outcomes were compared among the three groups.

Results: There were no significant differences in age, sex, or distribution of hepatitis cause. The Cirrhosis B group showed statistically higher total bilirubin level, lower serum albumin level, lower prothrombin time, higher indocyanine green retention rate at 15 min, and higher α-fetoprotein level than the Cirrhosis A and Non-cirrhosis groups. The operative outcomes including operative time, blood loss, transfusion rate, mortality and morbidity rates, and postoperative hospital stay were comparable among the three groups.

Conclusions: Laparoscopic liver resection for HCC in patients with Child-Pugh class B cirrhosis is as feasible as that in those with Child-Pugh class A liver cirrhosis or no cirrhosis.

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