Laparoscopic Versus Open Major Liver Resection For Hepatocellular Carcinoma: A Case-matched Analysis Of Short-and Long-term Outcomes

Background: Primary liver cancer is the sixth most common cancer worldwide and ranks third among all cancers in terms of cancer-related mortality.Recently,surgical resection is still the most effective therapeutic approach of liver cancer.Laparoscopic major hepatectomy(LMH),as a common surgical procedure for the treatment of massive hepatocellular carcinoma,has gradually attracted the attention of surgeons.However,the feasibility and safety of LMH is still uncertain.The purpose of the present study is to compare the short-and long-term outcomes of LMH with those of open major hepatectomy(OMH)for hepatocellular carcinoma(HCC).Method: The clinical data of 26 patients submitted to LMH and 78 patients submitted to OMH from January 2012 to December 2018 at the Second Affiliated Hospital of Nanchang University were evaluated.To minimize any confounding factors,a 1:3 case-matched analysis was conducted based on the demographics and extent of liver resection.Data of demographics,perioperative outcomes and long-term oncologic outcomes were reviewed.Results: Compared with OMH group,intraoperative blood loss(P=0.007)were significantly lower in LMH group.And LMH group exhibited a lower overall complication rate(P=0.039)and shorter postoperative hospital stay(P=0.024).However,no statistically significant difference was found between LMH and OMH regarding operation time(P=0.215)and overall cost(P=0.860).In regard with long-term outcomes,there was no significant difference between LMH and OMH regarding disease-free survival(DFS)(P=0.079)and overall survival(OS)(P=0.172).Conclusion: Compared with OMH,LMH has advantages in intraoperative blood loss,total postoperative complications,postoperative hospital stay and overall cost.And there is no significant difference in long-term outcomes between LMH group and OMH group.Thus,LMH can be an effective and safe alternative to OMH for selected patients with liver cancer in short-and long-term outcomes.