Is laparoscopic major hepatectomy superior to open major hepatectomy for liver cancer? A m,atched case-control Study

Abstract

INTRODUCTION: Laparoscopic liver resection is increasingly performed for both primary and secondary liver tumors due to improved technique and equipment. Nevertheless, the most common type of resection is, by enlarge, minor resections including wedge resection or left lateral sectionectomy. Its application to major resection, ie more than 3 Couinaud’s segments is still regarded as an investigational procedure in the Morioka consensus statement. Hence, our aim was to evaluate the outcome of laparoscopic major hepatectomy (LH) when compared with open major resection (OH). METHODS: From January 2010 to December 2016, clinical data was reviewed for 26 patients with LH. The LH group was matched with OH group for age, liver function, and tumor characteristics in a 1:2 ratio. RESULTS: There was no difference in age, Child-Pugh grading and tumor characteristics between LH and OH group. Tumor size was 3.9 cm and 4.0 cm for LH and OH group respectively. Right epatectomy was the most frequently performed (LH vs OH: 61.5% vs 63.5%), followed by left hepatectomy (30.8% vs 23.1%) and extended right hepatectomy (7.7% vs. 13.5%). Operating time for LH and OH was 402.5 and 373.5 minutes, blood loss was 350 ml and 560 ml, and length of stay was 6 days and 7 days respectively. No difference in postoperative outcome was observed. The 5-year survival rate for LH and OH for hepatocellular carcinoma was 71.6% and 63.9% (p¼0.959) and for colorectal liver metastasis was 100% and 57.8% (p¼0.183). CONCLUSIONS: LH was associated with less blood loss and shorter hospital stay than OH with similar oncological outcome.