Short- and long-term outcomes of laparoscopic versus open liver resection for large hepatocellular carcinoma: a propensity score study

• Published in: Surgery today (Tokyo, Japan) Vol. 53; no. 3; pp. 322 - 331
• Main Authors: Zhang, Kang-Jun, Liang, Lei, Diao, Yong-Kang, Xie, Ya-Ming, Wang, Dong-Dong, Xu, Fei-Qi, Ye, Tai-Wei, Lu, Wen-Feng, Cheng, Jian, Shen, Guo-Liang, Yao, Wei-Feng, Lu, Yi, Xiao, Zun-Qiang, Zhang, Jun-Gang, Zhang, Cheng-Wu, Huang, Dong-Sheng, Liu, Jun-Wei
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.03.2023
• Subjects: Carcinoma, Hepatocellular - surgery; Hepatectomy; Humans; Laparoscopy - adverse effects; Length of Stay; Liver Neoplasms - surgery; Medicine; Medicine & Public Health; Original Article; Propensity Score; Retrospective Studies; Surgery; Surgical Oncology; Propensity score matching; Hepatocellular carcinoma; Inverse probability treatment weighting; Laparoscopic; Overall survival
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-022-02576-7

Purpose Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) remains controversial, especially for tumors larger than 5 cm. We compared the short- and long-term outcomes of laparoscopic and open liver resection (OLR) for large HCC. Methods Patients with large HCC after curative hepatectomy were enrolled. To compare the short-term outcomes, propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were performed to reduce the effect of confounding factors, respectively. Subsequently, Cox-regression analyses were conducted to identify the independent risk factors associated with decreased recurrence-free survival (RFS) and poor overall survival (OS). Result There were 265 patients enrolled in the final analysis: 146 who underwent OLR and 119 who underwent LLR. There was no significant difference between the OLR and LLR groups according to PSM and IPTW analysis (all P  > 0.05). Multivariable analysis revealed that LLR was not independently associated with poorer OS (HR 1.15, 95% CI 0.80–1.67, P  = 0.448) or RFS (HR 1.22, 95% CI 0.88–1.70, P  = 0.238). Conclusion There were no significant differences in perioperative complications or long-term prognosis between LLR and OLR for large HCC, which provides evidence for standard laparoscopic surgical practice with adequate surgeon experience and careful patient selection.