Comparative Analysis Of Clinical Outcome Between Laparoscopic And Open Major Hepatectomy For Hepatocellular Carcinoma

Background Laparoscopic major hepatectomy(LMH)for hepatocellular carcinoma(HCC)in patients is currently perceived a complex and challenging laparoscopic procedure and is limited to a few expert teams.The safety,feasibility and reproducibility of this technique in the treatment of hepatocellular carcinoma remains controversial due to limited reports in the literature.This study analyzed the short-term efficacy and oncologic outcomes of LMH for HCC compared with open major hepatectomy(OMH).Method A retrospective analysis of 230 patients who underwent major hepatectomy for HCC in the department of Hepatobiliary surgery,Fujian Provincial Hospital between June 1st,2012 and January 1st,2016 was performed.These patients following the inclusion and exclusion criteria were divided into LMH group(laparoscopic major hepatectomy group)and OMH group(open major hepatectomy group).Short-term efficacy and oncological outcomes were compared before and after 1:1 propensity score matching(PSM).Result A total of 112 HCC patients following the inclusion and exclusion criteria received major liver resection were enrolled.There were 34(30.4%)patients in the LMH group and 78(69.6%)patients in the OMH group.After 1:1 PSM,there are 27 patients(50%)in the LMH group and OMH group respectively.Significant differences were observed in operative time and the rate of postoperative ascites between two groups before PSM(248.21±9.54 vs.211.68±6.45 min,p<0.05),(11.8% vs.29.5%,p<0.05),respectively.They were also significantly different between the LMH group and OMH group after PSM(247.56±11.06 vs.205.96±8.67 min,p<0.05),(7.4% vs.29.6%,p<0.05),respectively.Then,the pedicle clamping rate was lower in the LMH group than that in the OMH group(11.8% vs.2.6%,p<0.05),even though there was no significant difference after PSM(11.1% vs.3.7%,p=0.299>0.05).Before PSM,the rates of liver-specific complications were comparable between two groups(14.7% vs.32.1%,p=0.057>0.05).However,they were statistically different after PSM(7.4% vs.33.3%,p<0.05).The rates of blood loss,blood transfusion rate,postoperative hospital stay,90-day mortality,overall complication rate and liverspecific complications rate(included: liver failure,hemorrhage,biliary leakage)did not differ both before and after PSM.The rates of general complications of the two groups in terms of respiratory infection,wound infection and pleural effusion didn’t differ before and after PSM.The oncological outcomes between the two groups were comparable with regard to 5-year overall survival rate(48.1% vs.44.4%,p=0.068>0.05)and 5-year disease-free survival rate(46.2% vs.44.4%,p=0.890>0.05),respectively.Then the mean overall survival were 37.1 months in the OMH group,while the mean overall survival were 39.7 months in the LMH group.Conclusion LMH for HCC patients showed comparable results in terms of short-term efficacy and oncological outcomes compared with traditional open procedure.LMH may serve as a safe and reliable alternative approach for selected HCC patients.