Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: A multi-institutional Japanese study

Abstract

Background The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. Methods Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. Results The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. Conclusion Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications. In this large propensity score matched study comparing laparoscopic and open liver resection for hepatocellular carcinoma, Takahara and colleagues confirmed that laparoscopic resection in selected patients is a recommended procedure associated with less blood loss, shorter hospital stay, and fewer postoperative complications than open resection, without compromising long-term outcomes. Table 3 Comparison of perioperative outcomes after propensity score matching (PSM) Matched-LLR (n = 387) Matched-OLR (n = 387) P Blood loss (ml) 158 (50, 450%) 400 (170, 675%) <0.001 RCC transfusion 28 (7.24%) 38 (9.82%) 0.198 FFP transfusion 17 (4.44%) 30 (7.85%) 0.049 Operation time (min) 294.4 ± 158.8 271.0 ± 130.0 0.025 Hospital stay (days) 13 (9, 18) 16 (11, 25) <0.001 Conversion Pure → Hybrid or HALS 7 (1.81%) - Pure → Open 7 (1.81%) - Hybrid or HALS → Open 11 (2.84%) - Accident Bleeding 9 (2.33%) 14 (3.79%) Injury of other organs 0 0 Others 1 (0.26%) 0 0.313 Complications 26 (6.72%) 50 (12.99%) 0.003 Ascites 7 12 Intraperitoneal abscess 4 4 Pleural effusion 2 5 Bile leak 5 9 Liver failure 2 7 Wound infection 1 4 Bleeding 1 1 Others 4 8 30 days mortality 0 1 (0.26%) 0.317 90 days mortality 1 (0.26%) 4 (1.03%) 0.178 FFP fresh frozen plasma, HALS hand-assisted laparoscopic surgery, RCC red cell concentration.