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. 2016 Oct-Dec;29(4):521-529.
doi: 10.20524/aog.2016.0067. Epub 2016 Jun 24.

Laparoscopic versus open liver resection for hepatocellular carcinoma: initial experience in Greece

Georgios C Sotiropoulos  1 , Nikolaos Machairas  1 , Paraskevas Stamopoulos  1 , Ioannis D Kostakis  1 , Dimitrios Dimitroulis  1 , Dimitrios Mantas  1 , Gregory Kouraklis  1
Affiliations

Laparoscopic versus open liver resection for hepatocellular carcinoma: initial experience in Greece

Georgios C Sotiropoulos et al. Ann Gastroenterol. 2016 Oct-Dec.

Abstract

Background: Liver resection represents the treatment of choice for a small proportion of patients with hepatocellular carcinoma (HCC), amenable to surgery. The remarkable evolution in surgical techniques during the last decades introduced laparoscopic hepatectomy in the operative management of HCC, even in the presence of liver cirrhosis. No comparative study on laparoscopic or open liver resection for HCC has been conducted in Greece yet.

Methods: Patients undergoing liver resection for HCC by one senior hepatobiliary surgeon in our Institution during the period 11/2011-02/2016 were prospectively sampled and retrospectively analyzed for the purposes of this study. Statistical analysis encompassed Student's t-test, Fisher's exact test, the Kaplan-Meier method/log rank test and Cox proportional hazard regression analyses.

Results: Eleven patients underwent laparoscopic and 21 open liver resection, respectively. Statistical differences between the 2 groups were observed for tumor size (P=0.04), major resections (P=0.01), Pringle maneuver (P=0.008), intraoperative blood transfusion (P=0.03), and duration of operation (P=0.004). Resection margins, and tumor recurrence showed no statistical differences. Three-year postoperative survival after laparoscopic and open hepatectomy was 100%, and 67%, respectively (P=0.06). Regression analysis for patient survival revealed prognostic value for BCLC staging, γ-glutamyl transferase levels, laparoscopic hepatectomy, UICC stage, Dindo-Clavien classification, and hospital stay. Laparoscopic hepatectomy remained as independent predictor of survival by multivariate analysis (P=0.0142).

Conclusion: Laparoscopic hepatectomy for HCC in chronic liver disease represents a safe and innovative treatment tool in the management of these patients under the presupposition of careful patient selection.

Keywords: Laparoscopic hepatectomy; hepatocellular carcinoma; hospital stay; liver cirrhosis; liver resection.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Kaplan-Meier patient survival analysis according to the type of hepatectomy
Figure 2
Figure 2
(A) Magnetic resonance imaging and (B) specimen, of a patient with hepatocellular carcinoma in segment VI in cirrhosis undergoing laparoscopic hepatectomy
Figure 3
Figure 3
Magnetic resonance imaging (A), operative field before (B) and after hepatectomy (D) as well as operative specimen (C) of a patient with hepatocellular carcinoma in segment VII in cirrhosis undergoing open hepatectomy
See this image and copyright information in PMC

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