Ahmed Shehta, MD1, Ho Seong Han, MD,, PhD2, Yoo Seok Yoon, MD,, PhD2, Jai Young Cho, MD,, PhD2, YoungRok Choi, MD2. 1Gastroenterology Surgical Center – Mansoura university, 2Seoul National University Bundang Hospital, Seoul National University
Liver surgery in cirrhotic patients result in higher morbidity and mortality rates compared to non-cirrhotic patients. Recently, there is increased acceptance of laparoscopic approach in liver surgery. However, few reports have evaluated LLR for hepatocellular carcinoma (HCC) in cirrhotic patients. Most of these reports are limited to easily accessible lesions, and enrolled small number of patients. Furthermore, few reported long term outcomes.
The aim of this study is to evaluate our experience of LLR for HCC and compare perioperative and long term outcomes between patients with and without liver cirrhosis.
Methods and Procedures:
We retrospectively reviewed the data of the 232 patients who underwent LLR for HCC at Seoul National University Bundang Hospital (SNUBH) between January 2004 and December 2013. Patients were divided into two groups according to the status of their liver parenchyma; with and without liver cirrhosis (LC). The LC was diagnosed on the base of histo-pathologic examination (F4 cirrhosis according to Metavir score).
LC group had 141 patients and Non-LC group had 91 patients.
There were no significant statistical difference between both groups regarding tumor number, site, and presence of lymph nodes. Non-LC group showed larger tumor size (LC = 2.5 cm, non-LC = 3 cm, p = 0.001).
More minor resections were done in LC group (LC = 124 (97.9%), non-LC = 71 (78%), p = 0.011). There were no significant statistical difference between both groups regarding operation time, blood loss, transfusion requirements, and intraoperative complications. No operative mortality occurred in both groups.
Non-LC group showed larger resection margin (LC = 0.8 cm, non-LC = 1.3 cm, p = 0.019).
There were no significant differences between both groups in hospital stay, postoperative complications.
Long-term oncologic outcomes were comparable between both groups regarding the recurrence rates (p = 0.067), overall survival rates (p = 0.908) and disease free survival rates (p = 0.197).
The 1-, 3-, 5- and 7-year overall survival rates were 91.7, 85.5, 79.4, and 70.1% in LC group, and were 93.9, 86, 79.5, and 72.3% in non-LC group respectively. The 1-, 3-,5- and 7-year disease free survival rates were 75.3, 52.4, 42.6, and 32.7% in LC group, and were 74.1, 57.6, 55.3, 50.2% in non-LC group respectively.
The current study shows that LLR for HCC is feasible in patients with cirrhosis. LLR in cirrhotic patients shows comparable results to non-cirrhotic patients in terms of peri-operative and long term outcomes. However, prospective comparative studies are still needed to confirm the superiority of LLR for HCC in cirrhotic patients.