Comparison Of Laparoscopy And Open Treatment Of Hepatocellular Carcinoma

Objective:To compare the advantages and disadvantages of laparoscopic and open approach in hepatocellular carcinoma(HCC)surgery,and to provide the information for clinical selection about these two surgical techniques in patients with HCC.Methods:A retrospective analysis of 202 hepatocellular carcinoma patients who had received surgery in the Second Afiliated Hospital of Zhejiang University between 2013 June and 2017 May was carried out.All these patients were divided into two groups:the laparoscopic approach group and open approach group,and the clinical information including the follow-up data of both groups were analyzed as well.Results:Among all 202 cases,seventy-seven patients received laparoscopic liver resection(LLR),and the other 125 patients received open liver resection(OR).The conversion rate of LLR was 10.3%(8/77).The LLR group patients had shorter hospital stay(7.5±3.6 VS 9.7±6.4 d,P=0.006),lower postoperative white blood cell count(WBC)(10.2±3.3 VS 12.4±3.9 g/L,P=0.001),lower C-reactive protein(CRP)(47.6±32.1 VS 71.6±53.5 mg/L,P=0.001),lower alanine aminotransferase(ALT)(235.9±207.5 VS 335.6±389.8 U/L,P=0.040),lower prothrombin time(PT)(15.8± 1.5 VS 16.4±2.7 S,P=0.042)when compared with the OR group.However,the postoperative albumin(Alb)in LLR group was higher than it in the OR group(31.6±3.9 VS 30.2±4.7 g/L,P=0.023).Furthermore,the surgerical complications incidence of level Ⅲ grade in the LLR group was lower than it in the OR group(x2=4.314,P=0.038),and there was a significant difference of disease free survival(DFS)between the two groups(x2=4.972,P=0.025).Further 1:1 paired subgroup analysis of 72 cases was carried out,and we found that patients in LLR group still had shorter hospital stay(7.9±3.6 VS 9.9±3.4 d,P=0.020),and lower postoperative of CRP when compared with the OR group,(39.1 ± 13.7 VS 61.8±39.7 mg/L,P=0.003),respectively.But no differences were found in the surgerical complications incidence or DFS data of both groups.Conclusion:The advantages of LLR include less inflammatory reaction,shorter postoperative hospital stay,and low the recurrence rate.Laparoscopic resection of HCC is feasible and safe,it should be the first choice of surgery for patients with HCC.