Laparoscopic versus open liver resection for small hepatocellular carcinoma: A case-control study

Wipusit Taesombat, MD, Bunthoon Nonthasoot, MD, Boonchoo Sirichindakul, MD, Jade Supaphol, MD, Methee Sutherasan, MD, Supanit Nivatwongs, MD. Department of Surgery, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Thailand

Introduction Laparoscopic liver resection (LR) is considered an alternative procedure to open liver resection (OR) with respect to safety and feasibility. However, the suitable indication for obtaining benefits of laparoscopic technique is remained challenging. The aim of this study was to compare peri-operative and survival outcomes between two techniques in patients with small hepatocellular carcinoma (HCC).

Methods Between January 2007 and January 2013, twenty-seven patients underwent LR were retrospectively matched to 29 patients underwent OR by age, body mass index, underlying liver disease, Child-Pugh classification, ASA physical status, preoperative alfa-fetoprotien level, tumor diameter and extent of liver resection. Peri-operative and long-term outcomes were compared between both groups.

Results The mean tumor diameter in LR was 3.8±1.6 cm and OR was 3.9±1.7 cm (p=0.9). On the first postoperative day, the mean level of white blood cell count (mean, 9,083.2±2,495.9 vs 16,491.9±18,570.9 cell/mm3, p=0.001), serum AST (171.9±119.3 vs 252.4±113.6 U/L, p=0.002) and ALT (149.3±120.7 vs 218.6±116.1 U/L, p=0.003) in LR were significant lower than OR. The LR had length of hospital stay shorter than OR (mean, 5.9±5.6 days vs 8.2±4.4 days, p=0.004). The morbidity was no significant difference between both groups. In subgroup of patients with pathologically proved cirrhosis, the drainage tubes was removed earlier in LR compare to OR (3.2±1.6 vs 4.9±2.5 days, p=0.02). The long-term survival outcomes were no significant difference. The 1-, 3- and 5-year disease free survival were 70.4%, 63% and 57.7% in LR and 82.2%, 66.8% and 61.6% in OR, respectively (p=0.6). The 1-, 3- and 5-year overall survival were 92.6%, 85.2% and 77.4% in LR and 100%, 88.8% and 64.8% in OR, respectively (p=0.9).

Conclusions In patients with small HCC undergoing laparoscopic liver resection have shorter length of hospital stay and lesser degree of liver injury than open liver resection whereas comparable peri-operative and long-term survival outcomes. 

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