Laparoscopic vs. Open Liver Resection for Hepatocellular Carcinoma of Cirrhotic Liver: A Case–Control Study

Background Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case–control study was to compare morbidity, mortality, and long-t...

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Published in:	World journal of surgery Vol. 38; no. 11; pp. 2919 - 2926
Main Authors:	Memeo, Riccardo, de’Angelis, Nicola, Compagnon, Philippe, Salloum, Chady, Cherqui, Daniel, Laurent, Alexis, Azoulay, Daniel
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01.11.2014 John Wiley & Sons, Inc
Subjects:	Abdominal Surgery Adult Aged Aged, 80 and over Carcinoma, Hepatocellular - complications Carcinoma, Hepatocellular - surgery Cardiac Surgery Cirrhotic Patient Disease-Free Survival Female Future Remnant Liver General Surgery Hepatectomy - methods Humans Laparoscopic Liver Resection Laparoscopy Length of Stay Liver Cirrhosis - complications Liver Cirrhosis - surgery Liver Neoplasms - complications Liver Neoplasms - surgery Liver Resection Male Medicine Medicine & Public Health Middle Aged Operative Time Postoperative Complications - etiology Retrospective Studies Short Operative Time Surgery Survival Rate Thoracic Surgery Vascular Surgery Short Operative Time Future Remnant Liver Cirrhotic Patient Laparoscopic Liver Resection Liver Resection
ISSN:	0364-2313, 1432-2323, 1432-2323
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Abstract	Background Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case–control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. Methods A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups. Results Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group ( p = 0.27). Conclusions Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.
AbstractList	Background Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case–control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. Methods A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups. Results Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group ( p = 0.27). Conclusions Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients. Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis.BACKGROUNDLaparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis.A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups.METHODSA total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups.Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27).RESULTSCompared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27).Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.CONCLUSIONSSignificantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients. Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups. Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27). Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.[PUBLICATION ABSTRACT] Background Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case–control study was to compare morbidity, mortality, and long‐term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. Methods A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child‐Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha‐fetoprotein value with 45 patients treated with OLR. Pre‐, intra‐, and post‐operative variables were compared between groups. Results Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease‐free survival rates were similar between groups. The 1‐, 5‐, and 10‐year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27). Conclusions Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease‐free survival rates in cirrhotic HCC patients. Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups. Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27). Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.
Author	Memeo, Riccardo de’Angelis, Nicola Azoulay, Daniel Laurent, Alexis Compagnon, Philippe Salloum, Chady Cherqui, Daniel
Author_xml	– sequence: 1 givenname: Riccardo surname: Memeo fullname: Memeo, Riccardo email: drmemeo@yahoo.it organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC – sequence: 2 givenname: Nicola surname: de’Angelis fullname: de’Angelis, Nicola organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC – sequence: 3 givenname: Philippe surname: Compagnon fullname: Compagnon, Philippe organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC – sequence: 4 givenname: Chady surname: Salloum fullname: Salloum, Chady organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC – sequence: 5 givenname: Daniel surname: Cherqui fullname: Cherqui, Daniel organization: Centre Hepatobiliaire, Hopital Paul Brousse, Université Paris Sud – sequence: 6 givenname: Alexis surname: Laurent fullname: Laurent, Alexis organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC – sequence: 7 givenname: Daniel surname: Azoulay fullname: Azoulay, Daniel organization: Digestive, HPB and Transplant Liver Surgery Unit, Henri-Mondor Hospital, Université Paris Est–Créteil, UPEC
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24912628$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Société Internationale de Chirurgie 2014 2014 The Author(s) under exclusive licence to Société Internationale de Chirurgie
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Keywords	Short Operative Time Future Remnant Liver Cirrhotic Patient Laparoscopic Liver Resection Liver Resection
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PublicationSubtitle	Official Journal of the International Society of Surgery/Société Internationale de Chirurgie
PublicationTitle	World journal of surgery
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PublicationYear	2014
Publisher	Springer US John Wiley & Sons, Inc
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References_xml	– volume: 16 start-page: 109 issue: 2 year: 2014 end-page: 118 ident: CR2 article-title: Laparoscopic versus open liver resection: a meta-analysis of long-term outcome publication-title: HPB (Oxford) doi: 10.1111/hpb.12117 – volume: 250 start-page: 738 year: 2009 end-page: 746 ident: CR21 article-title: Liver resection for transplantable hepatocellular carcinoma: long-term survival and role of secondary liver transplantation publication-title: Ann Surg doi: 10.1097/SLA.0b013e3181bd582b – volume: 250 start-page: 825 issue: 5 year: 2009 end-page: 830 ident: CR30 article-title: The international position on laparoscopic liver surgery: the Louisville statement publication-title: Ann Surg doi: 10.1097/SLA.0b013e3181b3b2d8 – volume: 243 start-page: 499 year: 2006 end-page: 506 ident: CR25 article-title: Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives publication-title: Ann Surg doi: 10.1097/01.sla.0000206017.29651.99 – volume: 144 start-page: 143 year: 2009 end-page: 147 ident: CR10 article-title: Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center publication-title: Arch Surg doi: 10.1001/archsurg.2008.536 – volume: 257 start-page: 377 year: 2012 end-page: 382 ident: CR14 article-title: Use and dissemination of the Brisbane 2000 Nomenclature of Liver Anatomy and Resections publication-title: Ann Surg doi: 10.1097/SLA.0b013e31825a01f6 – volume: 131 start-page: 311 year: 2002 end-page: 317 ident: CR17 article-title: Extent of liver resection influences the outcome in patients with cirrhosis and small hepatocellular carcinoma publication-title: Surgery doi: 10.1067/msy.2002.121892 – volume: 250 start-page: 772 year: 2009 end-page: 782 ident: CR18 article-title: The learning curve in laparoscopic liver resection: improved feasibility and reproducibility publication-title: Ann Surg doi: 10.1097/SLA.0b013e3181bd93b2 – volume: 146 start-page: 348 year: 2011 end-page: 356 ident: CR29 article-title: Comparative benefits of laparoscopic vs open hepatic resection publication-title: Arch Surg doi: 10.1001/archsurg.2010.248 – volume: 16 start-page: 410 year: 2009 end-page: 421 ident: CR8 article-title: Laparoscopic liver resection: a systematic review publication-title: J Hepatobiliary Pancreat Surg doi: 10.1007/s00534-009-0120-8 – volume: 240 start-page: 205 year: 2004 end-page: 213 ident: CR15 article-title: Classification of surgical complications publication-title: Ann Surg doi: 10.1097/01.sla.0000133083.54934.ae – volume: 7 start-page: 462 year: 1954 end-page: 503 ident: CR16 article-title: Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies publication-title: Cancer doi: 10.1002/1097-0142(195405)7:3<462::AID-CNCR2820070308>3.0.CO;2-E – volume: 196 start-page: 236 issue: 2 year: 2003 end-page: 242 ident: CR22 article-title: Laparoscopic versus open left lateral hepatic lobectomy: a case–control study publication-title: J Am Coll Surg doi: 10.1016/S1072-7515(02)01622-8 – volume: 15 start-page: 800 year: 2008 end-page: 806 ident: CR23 article-title: Laparoscopic liver surgery for patients with hepatocellular carcinoma publication-title: Ann Surg Oncol doi: 10.1245/s10434-007-9749-1 – volume: 17 start-page: 23 year: 2003 end-page: 30 ident: CR19 article-title: Laparoscopic liver resection of benign liver tumors publication-title: Surg Endosc doi: 10.1007/s00464-002-9047-8 – volume: 45 start-page: 2333 issue: 24 year: 1998 end-page: 2338 ident: CR24 article-title: Laparoscopic liver resection compared with conventional partial hepatectomy: a prospective analysis publication-title: Hepatogastroenterology – volume: 15 start-page: 78 year: 2013 end-page: 84 ident: CR13 article-title: Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh’s A cirrhosis: is clinical evidence of portal hypertension a contraindication? publication-title: HPB (Oxford) doi: 10.1111/j.1477-2574.2012.00594.x – volume: 22 start-page: 2350 year: 2008 end-page: 2356 ident: CR9 article-title: Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors publication-title: Surg Endosc doi: 10.1007/s00464-008-9789-z – volume: 138 start-page: 763 year: 2003 end-page: 769 ident: CR4 article-title: Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease publication-title: Arch Surg doi: 10.1001/archsurg.138.7.763 – volume: 21 start-page: 2004 year: 2007 end-page: 2011 ident: CR5 article-title: Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results publication-title: Surg Endosc doi: 10.1007/s00464-007-9503-6 – volume: 12 start-page: 331 year: 1998 end-page: 334 ident: CR20 article-title: Laparoscopic liver surgery. 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Snippet	Background Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic... Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in...
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SubjectTerms	Abdominal Surgery Adult Aged Aged, 80 and over Carcinoma, Hepatocellular - complications Carcinoma, Hepatocellular - surgery Cardiac Surgery Cirrhotic Patient Disease-Free Survival Female Future Remnant Liver General Surgery Hepatectomy - methods Humans Laparoscopic Liver Resection Laparoscopy Length of Stay Liver Cirrhosis - complications Liver Cirrhosis - surgery Liver Neoplasms - complications Liver Neoplasms - surgery Liver Resection Male Medicine Medicine & Public Health Middle Aged Operative Time Postoperative Complications - etiology Retrospective Studies Short Operative Time Surgery Survival Rate Thoracic Surgery Vascular Surgery
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Title	Laparoscopic vs. Open Liver Resection for Hepatocellular Carcinoma of Cirrhotic Liver: A Case–Control Study
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