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Short- and long-term outcomes of laparoscopic versus open liver resection for large hepatocellular carcinoma: a propensity score study

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Abstract

Purpose

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) remains controversial, especially for tumors larger than 5 cm. We compared the short- and long-term outcomes of laparoscopic and open liver resection (OLR) for large HCC.

Methods

Patients with large HCC after curative hepatectomy were enrolled. To compare the short-term outcomes, propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were performed to reduce the effect of confounding factors, respectively. Subsequently, Cox-regression analyses were conducted to identify the independent risk factors associated with decreased recurrence-free survival (RFS) and poor overall survival (OS).

Result

There were 265 patients enrolled in the final analysis: 146 who underwent OLR and 119 who underwent LLR. There was no significant difference between the OLR and LLR groups according to PSM and IPTW analysis (all P > 0.05). Multivariable analysis revealed that LLR was not independently associated with poorer OS (HR 1.15, 95% CI 0.80–1.67, P = 0.448) or RFS (HR 1.22, 95% CI 0.88–1.70, P = 0.238).

Conclusion

There were no significant differences in perioperative complications or long-term prognosis between LLR and OLR for large HCC, which provides evidence for standard laparoscopic surgical practice with adequate surgeon experience and careful patient selection.

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Abbreviations

HCC:

Hepatocellular carcinoma

LLR:

Laparoscopic liver resection

OLR:

Open liver resection

RFS:

Recurrence-free survival

OS:

Overall survival

BMI:

Body mass index

PS:

Performance status

PLT:

Platelet count

ALT:

Alanine aminotransferase

AST:

Aspartate transaminase

AFP:

Alpha-fetoprotein

HR:

Hazard ratio

CI:

Confidence interval

PSM:

Propensity score matching

IPTW:

Inverse probability treatment weighting

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Funding

Funding for the study was provided by Zhejiang Provincial People’s Hospital (No. ZRY2020A004), Health Commission of Zhejiang Province (No.2022KY532, No.2018KY261), General scientific research project of Education Department of Zhejiang Province (No.Y201840617) and Lishui Public welfare technology application research project (No. 2022GYX50).

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Authors and Affiliations

  1. General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China

    Kang-Jun Zhang, Lei Liang, Yong-Kang Diao, Ya-Ming Xie, Dong-Dong Wang, Fei-Qi Xu, Tai-Wei Ye, Jian Cheng, Guo-Liang Shen, Wei-Feng Yao, Yi Lu, Zun-Qiang Xiao, Jun-Gang Zhang, Cheng-Wu Zhang, Dong-Sheng Huang & Jun-Wei Liu

  2. Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China

    Lei Liang, Ya-Ming Xie, Dong-Dong Wang, Fei-Qi Xu & Tai-Wei Ye

  3. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China

    Wen-Feng Lu

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Contributions

K-JZ, LL, Y-KD and Y-MX contributed equally to this work. Dr J-WL and D-SH had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: K-JZ, LL, D-SH and J-WL. Acquisition, analysis, or interpretation of data: D-DW, F-QX, T-WY, W-FL, JC, G-LS, W-FY, YL, and Z-QX. Drafting of the manuscript: K-JZ and LL. Critical revision of the manuscript for important intellectual content: J-GZ and C-WZ. Statistical analysis: K-JZ and Y-KD. Obtained funding: LL. Administrative, technical, or material support: C-WZ, and J-WL. Study supervision: D-SH and J-WL. Correspondence to: Dr. Jun-Wei Liu, or Dr. Dong-Sheng Huang.

Corresponding author

Correspondence to Jun-Wei Liu.

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The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

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Zhang, KJ., Liang, L., Diao, YK. et al. Short- and long-term outcomes of laparoscopic versus open liver resection for large hepatocellular carcinoma: a propensity score study. Surg Today 53, 322–331 (2023). https://doi.org/10.1007/s00595-022-02576-7

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  • DOI: https://doi.org/10.1007/s00595-022-02576-7

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