Long-term surgical outcomes in patients with hepatocellular carcinoma undergoing laparoscopic vs. open liver resection: A retrospective and propensity score-matched study

Background/objectives There is limited availability of well-designed comparative studies using propensity score matching with a sufficient sample size to compare laparoscopic liver resection (LLR) vs. open liver resection (OLR) for hepatocellular carcinoma (HCC). We aimed to compare the feasibility and safety of LLR and OLR in patients with HCC. Methods We enrolled 168 patients who underwent elective LLR (n = 58) or OLR (n = 110) for HCC in two tertiary medical centers between November 2009 and December 2018. Patients who underwent LLR were propensity score-matched to patients who underwent OLR in a 1:1 ratio. Perioperative and postoperative outcomes and disease-free and overall survival rates were prospectively evaluated. Results Among the 116 patients analyzed, 58 each belonged to the LLR and OLR groups. We performed 85 segmentectomies or sectionectomies, 19 left-lateral-sectionectomies, 9 left-hemihepatectomies, and 3 right-hemihepatectomies. There was no significant difference in age, sex, Child-Pugh class, original liver disease, preoperative alpha-fetoprotein, tumor size, tumor location, overall morbidity, and operative time. There was a significant difference in the length of postoperative hospital stay between the two groups (LLR vs OLR; 8 vs 10 days, p = 0.003). The 1-, 3-, and 5-year overall survival rates in the LLR and OLR groups were 96.6%, 92.8%, and 73.3% and 93.1%, 88.8%, and 76.1%, respectively (p = 0.642). The 1-, 3-, and 5-year disease-free survival rates in the LLR and OLR groups were 84.4%, 64.0%, and 60.2% and 93.1%, 67.4%, and 63.9%, respectively (p = 0.391). Conclusion LLR for HCC can be performed safely with acceptable short-term and long-term outcomes compared with OLR.