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Short- and long-term outcomes of laparoscopic versus open hepatectomy for small malignant liver tumors: a single-center experience

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Abstract

Background

Laparoscopic hepatectomy (Lap-Hx) has been increasingly performed for patients with liver tumors as surgical techniques and devices have progressed. However, the long-term outcomes of Lap-Hx for malignant liver tumors are not oncologically guaranteed. This study compared the short- and long-term outcomes between Lap-Hx and open hepatectomy (Open-Hx) for malignant liver tumors by matched-pair analysis.

Methods

The indications for Lap-Hx at our department are a tumor size of <5 cm and fewer than two lesions without macroscopic vascular invasion or the need for biliary reconstruction. In total, 135 patients underwent Lap-Hx for malignant liver tumors through December 2013. We compared the short- and long-term outcomes between Lap-Hx and Open-Hx in patients who met the above-mentioned indications.

Results

With respect to short-term outcomes, the operation time, blood loss, postoperative hospital stay, white blood cell count, and C-reactive protein level after Lap-Hx were significantly better than those after Open-Hx in both the patients who underwent partial resection and those who underwent lateral sectionectomy. In patients who underwent partial resection, the incidence of postoperative complications after Lap-Hx was significantly lower than that after Open-Hx; in particular, wound infection and respiratory complications were significantly lower. Furthermore, when the tumor was located in the posterosuperior segments, the operation time for Lap-Hx was not shorter than that for Open-Hx. With respect to long-term outcomes of hepatocellular carcinoma, neither overall nor disease-free survival differed between the two groups. With respect to long-term outcomes of colorectal liver metastases, the disease-free survival rate was similar between Lap-Hx and Open-Hx; however, the overall survival rate was significantly better for Lap-Hx than for Open-Hx.

Conclusions

Lap-Hx is a good option for selected patients with malignant liver tumors. The short- and long-term outcomes of Lap-Hx also are considered to be acceptable.

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Disclosures

Drs. Fumitoshi Hirokawa, Michihiro Hayashi, Yoshiharu Miyamoto, Mitsuhiro Asakuma, Tetsunosuke Shimizu, Koji Komeda, Yoshihiro Inoue, and Kazuhisa Uchiyama have no conflict of interests or financial ties to disclose.

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Fumitoshi Hirokawa, Michihiro Hayashi, Yoshiharu Miyamoto, Mitsuhiro Asakuma, Tetsunosuke Shimizu, Koji Komeda, Yoshihiro Inoue & Kazuhisa Uchiyama

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  1. Fumitoshi Hirokawa
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  2. Michihiro Hayashi
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  3. Yoshiharu Miyamoto
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  4. Mitsuhiro Asakuma
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  5. Tetsunosuke Shimizu
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  6. Koji Komeda
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  7. Yoshihiro Inoue
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  8. Kazuhisa Uchiyama
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Correspondence to Fumitoshi Hirokawa.

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Hirokawa, F., Hayashi, M., Miyamoto, Y. et al. Short- and long-term outcomes of laparoscopic versus open hepatectomy for small malignant liver tumors: a single-center experience. Surg Endosc 29, 458–465 (2015). https://doi.org/10.1007/s00464-014-3687-3

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  • DOI: https://doi.org/10.1007/s00464-014-3687-3

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