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. 2023 Dec 1;12(6):824-834.
doi: 10.21037/hbsn-21-578. Epub 2022 Sep 12.

Laparoscopic anatomical versus non-anatomical liver resection for hepatocellular carcinoma in the posterosuperior segments: a propensity score matched analysis

Boram Lee  1 , Jai Young Cho  1 , Ho-Seong Han  1 , Yoo-Seok Yoon  1 , Hae Won Lee  1 , Jun Suh Lee  1 , Moonhwan Kim  1 , Yeongsoo Jo  1
Affiliations

Laparoscopic anatomical versus non-anatomical liver resection for hepatocellular carcinoma in the posterosuperior segments: a propensity score matched analysis

Boram Lee et al. Hepatobiliary Surg Nutr. .

Abstract

Background: Since laparoscopic anatomical resection (LAR) for tumors, especially located in the posterosuperior (PS) segments of the liver remains difficult, laparoscopic non-anatomical resection (LNAR) are generally preferred. To compare the clinical outcomes between LAR and LNAR for hepatocellular carcinoma (HCC) located in the PS segments.

Methods: We retrospectively reviewed the data for 1,029 patients who underwent hepatectomy for HCC between 2004 and 2019. Of 167 patients who underwent laparoscopic hepatectomy for HCC in PS segments, 64 underwent LNAR and 103 underwent LAR. Patients were matched one-to-one using propensity score matching (46:46).

Results: LNAR was associated with significantly shorter operation time (P=0.001), lower estimated blood loss (P=0.001), lower transfusion rate (P=0.006) and shorter hospital stay (P=0.012) than LAR. The respective 1- ,3-, and 5-year overall survival rates (LAR: 95.3%, 87.1%, and 77.8%; LNAR: 96.7%, 91.6%, and 85.0%; P=0.262) and recurrence-free survival rates (LAR: 75.7%, 70.3%, and 68.9%; LNAR: 81.8%, 58.3%, and 55.3%; P=0.879) were similar. The intrahepatic recurrence rate was significantly higher in LNAR group than in LAR group (78.6% vs. 57.1%, P=0.023), but the post-recurrence treatments differed significantly between the two groups (P=0.016); the re-resection rate was much greater in the LNAR group (45.0% vs. 0%) group. The respective 1-, 3-, and 5-year post-recurrence survival rates were similar in the LAR and LNAR groups (P=0.212). After recurrence, survival in re-resection group was significantly greater than not (P=0.026).

Conclusions: LNAR is safe and feasible for HCC located in PS segments, and provided acceptable oncologic outcomes that are comparable to those of LAR. LNAR can be considered for patient with tumor located in PS segment when LAR is not feasible.

Keywords: Laparoscopy; carcinoma, hepatocellular; hepatectomy; recurrence.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-21-578/coif). H.S.H. serves as an unpaid editorial board member of Hepatobiliary Surgery and Nutrition. J.Y.C. receives support (Grant No. 02-2021-046) from Seoul National University Bundang Hospital Research Fund. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient flow chart. LLR, laparoscopic liver resection; PS, posterosuperior; HCC-CCC, hepatocellular carcinoma-cholangiocarcinoma; LAR, laparoscopic anatomical resection; LNAR, laparoscopic non-anatomical resection.
Figure 2
Figure 2
Survival curve of patients undergoing LAR and LNAR for PS lesions in the propensity-matched group. (A) Overall survival; (B) recurrence free survival. LNAR, laparoscopic non-anatomical resection; LAR, laparoscopic anatomical resection; PS, posterosuperior.
Figure 3
Figure 3
SAR of patients in the propensity-matched group. (A) Overall SAR curves; (B) SAR curve based on the treatment type after recurrence. LNAR, laparoscopic non-anatomical resection; LAR, laparoscopic anatomical resection; LT, locoregional treatment; PT, palliative treatment; SAR, survival after recurrence.
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References

    1. Kim JM, Kwon CH, Joh JW, et al. Differences between hepatocellular carcinoma and hepatitis B virus infection in patients with and without cirrhosis. Ann Surg Oncol 2014;21:458-65. 10.1245/s10434-013-3302-1 - DOI - PubMed
    1. Ishii M, Mizuguchi T, Kawamoto M, et al. Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma. World J Gastroenterol 2014;20:3335-42. 10.3748/wjg.v20.i12.3335 - DOI - PMC - PubMed
    1. Kang KJ, Ahn KS. Anatomical resection of hepatocellular carcinoma: A critical review of the procedure and its benefits on survival. World J Gastroenterol 2017;23:1139-46. 10.3748/wjg.v23.i7.1139 - DOI - PMC - PubMed
    1. Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 1985;161:346-50. - PubMed
    1. Torimura T, Iwamoto H. Optimizing the management of intermediate-stage hepatocellular carcinoma: Current trends and prospects. Clin Mol Hepatol 2021;27:236-45. 10.3350/cmh.2020.0204 - DOI - PMC - PubMed