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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Vydáno v:World journal of surgery Ročník 38; číslo 11; s. 2919 - 2926
Hlavní autoři: Memeo, Riccardo, de’Angelis, Nicola, Compagnon, Philippe, Salloum, Chady, Cherqui, Daniel, Laurent, Alexis, Azoulay, Daniel
Médium: Journal Article
Jazyk:angličtina
Vydáno: Boston Springer US 01.11.2014
John Wiley & Sons, Inc
Témata:
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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Shrnutí: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.
Bibliografie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:0364-2313
1432-2323
1432-2323
DOI:10.1007/s00268-014-2659-z