Pure laparoscopic versus open major hepatectomy for hepatocellular carcinoma with liver F4 cirrhosis without routine Pringle maneuver - A propensity analysis in a single center.
BACKGROUND
/Aim: Laparoscopic hepatectomy has been gaining popularity but its evidence in major hepatectomy for cirrhotic liver is lacking. We studied the long-term outcomes of the pure laparoscopic approach versus the open approach in major hepatectomy without Pringle maneuver in patients with hepatocellular carcinoma (HCC) and cirrhosis using the propensity score analysis.


METHODS
We reviewed patients diagnosed with HCC and cirrhosis who underwent major hepatectomy as primary treatment. The outcomes of patients who received the laparoscopic approach were compared with those of propensity-case-matched patients (ratio, 4:1) who received the open approach. The matching was made on the following factors: tumor size, tumor number, age, sex, hepatitis serology, HCC staging, comorbidity, and liver function.


RESULTS
Twenty-four patients underwent pure laparoscopic major hepatectomy for HCC with cirrhosis. Ninety-six patients who underwent open major hepatectomy were matched by propensity scores. The laparoscopic group had less median blood loss (300 ml vs 645 ml, p = 0.001), shorter median hospital stay (6 days vs 10 days, p = 0.002), and lower rates of overall complication (12.5% vs 39.6%, p = 0.012), pulmonary complication (4.2% vs 25%, p = 0.049) and pleural effusion (p = 0.026). The 1-year, 3-year and 5-year overall survival rates in the laparoscopic group vs the open group were 95.2%, 89.6% and 89.6% vs 87.5%, 72.0% and 62.8% (p = 0.211). Correspondingly, the disease-free survival rates were 77.1%, 71.2% and 71.2% vs 75.8%, 52.7% and 45.5% (p = 0.422).


CONCLUSIONS
The two groups had similar long-term survival. The laparoscopic group had favorable short-term outcomes. Laparoscopic major hepatectomy without routine Pringle maneuver for HCC with cirrhosis is a safe treatment option at specialized centers.
['Cheung|Tan To|TT|', 'Ma|Ka Wing|KW|', 'She|Wong Hoi|WH|', 'Dai|Wing Chiu|WC|', 'Tsang|Simon H Y|SHY|', 'Chan|Albert C Y|ACY|', 'Lo|Chung Mau|CM|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D005260:Female D006498:Hepatectomy D006723:Hong Kong D006801:Humans D010535:Laparoscopy D007902:Length of Stay D008103:Liver Cirrhosis D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D061646:Operative Time D011183:Postoperative Complications D057216:Propensity Score D011446:Prospective Studies D015996:Survival Rate D016896:Treatment Outcome
Cirrhosis HCC Complex liver surgery Laparoscopic liver resection Liver cancer Survival analysis Technique