Masateru Yamamoto1, Tsuyoshi Kobayashi2, Akihiko Oshita3, Tomoyuki Abe4, Toshihiko Kohashi5, Takashi Onoe6, Saburo Fukuda7, Ichiro Omori8, Yasuhiro Imaoka9, Naruhiko Honmyo1, Hideki Ohdan1. 1. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University Hospital, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8551, Japan. 2. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University Hospital, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8551, Japan. tsukoba@hiroshima-u.ac.jp. 3. Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami Ward, Hiroshima, 734-8530, Japan. 4. Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan. 5. Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita Ward, Hiroshima, 731-0293, Japan. 6. National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Institute for Clinical Research, 3-1, Aoyamacho, Kure, Hiroshima, 737-0023, Japan. 7. Department of Surgery, Chugoku Rosai Hospital, 1-5-1 Hirotagaya, Kure, 737-0193, Japan. 8. Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513, Jike, Saijyo-cho, Higashihiroshima, Hiroshima, 739-0041, Japan. 9. Department of Surgery, National Hospital Organization Hiroshima-Nishi Medical Center, 4-1-1 Kuba, Otake, Hiroshima, 739-0696, Japan.
Abstract
BACKGROUND: Laparoscopic liver resection (LLR) has evolved as a safe and effective alternative to conventional open liver resection (OLR) for malignant lesions. However, LLR in cirrhotic patients remains challenging. This study analyzed the perioperative and oncological outcomes of LLR for hepatocellular carcinoma (HCC) with cirrhosis compared with OLR using propensity score matching. METHODS: A multicenter retrospective analysis of records of patients who underwent limited liver resection for HCC and were histologically diagnosed with liver cirrhosis between January 2009 and December 2017 in the eight institutions belonging to the Hiroshima Surgical study group of Clinical Oncology was performed. The patients were divided into two groups: the LLR and OLR groups. After propensity score matching, we compared clinicopathological features and outcomes. RESULTS: In total 256 patients with histological liver cirrhosis who underwent limited liver resection for HCC were included in this study; 58 patients had undergone LLR, and the remaining 198 patients OLR. The number of tumors was higher, tumor size was larger, and difficulty score was significantly higher in the OLR group before propensity matching. After the matching, the data of the well-matched 58 patients in each group were evaluated; the intraoperative blood loss was lower in the LLR group (p = 0.004), and incidence of the postoperative complications was significantly higher in the OLR group (p = 0.019). The duration of the postoperative hospital stay was significantly shorter in the LLR group (p < 0.001). There were no differences between two groups in overall survival and recurrent-free survival. CONCLUSIONS: LLR decreased the incidences of postoperative complications, shortened the duration of postoperative hospital stay. Thus, LLR is a safe and feasible procedure even in patients with cirrhosis.
BACKGROUND: Laparoscopic liver resection (LLR) has evolved as a safe and effective alternative to conventional open liver resection (OLR) for malignant lesions. However, LLR in cirrhoticpatients remains challenging. This study analyzed the perioperative and oncological outcomes of LLR for hepatocellular carcinoma (HCC) with cirrhosis compared with OLR using propensity score matching. METHODS: A multicenter retrospective analysis of records of patients who underwent limited liver resection for HCC and were histologically diagnosed with liver cirrhosis between January 2009 and December 2017 in the eight institutions belonging to the Hiroshima Surgical study group of Clinical Oncology was performed. The patients were divided into two groups: the LLR and OLR groups. After propensity score matching, we compared clinicopathological features and outcomes. RESULTS: In total 256 patients with histological liver cirrhosis who underwent limited liver resection for HCC were included in this study; 58 patients had undergone LLR, and the remaining 198 patients OLR. The number of tumors was higher, tumor size was larger, and difficulty score was significantly higher in the OLR group before propensity matching. After the matching, the data of the well-matched 58 patients in each group were evaluated; the intraoperative blood loss was lower in the LLR group (p = 0.004), and incidence of the postoperative complications was significantly higher in the OLR group (p = 0.019). The duration of the postoperative hospital stay was significantly shorter in the LLR group (p < 0.001). There were no differences between two groups in overall survival and recurrent-free survival. CONCLUSIONS: LLR decreased the incidences of postoperative complications, shortened the duration of postoperative hospital stay. Thus, LLR is a safe and feasible procedure even in patients with cirrhosis.