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Pure Laparoscopic Versus Open Right Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis: A Propensity Score Matched Analysis

Yoon, Young-In MD, PhD*,†; Kim, Ki-Hun MD, PhD*; Kang, Sung-Hwa MD; Kim, Wan-Joon MD*; Shin, Min-Ho MD*,§; Lee, Sang-Kyung RN*; Jung, Dong-Hwan MD, PhD*; Park, Gil-Chun MD, PhD*; Ahn, Chul-Soo MD, PhD*; Moon, Deok-Bog MD, PhD*; Ha, Tae-Yong MD, PhD*; Song, Gi-Won MD, PhD*; Hwang, Shin MD, PhD*; Lee, Sung-Gyu MD, PhD*

doi: 10.1097/SLA.0000000000002072
Features

Objective: We aimed to describe our experience with pure laparoscopic right hepatectomy (LRH) and to compare its outcomes with those of open right hepatectomy (ORH) in hepatocellular carcinoma (HCC) patients with liver cirrhosis.

Background: Laparoscopic liver resection has been reported as a safe and effective approach for the management of liver cancer; however, its outcomes have not been evaluated in a large cohort of HCC patients with liver cirrhosis.

Methods: We retrospectively reviewed the medical records of 152 patients who underwent pure LRH (n = 37) or ORH (n = 115) between June 2008 and July 2015 at the Asan Medical Center in Seoul, Korea. We performed 1:1 propensity score matching between the LRH and ORH groups. Subsequently, 33 patients were included in each group.

Results: There was no statistically significant difference between the LRH and ORH groups regarding the rate of complications (P = 0.053). However, the mean comprehensive complication index, which accounts for the severity of complications, was significantly lower in the LRH group (0.63 vs 4.42; P = 0.025). There were no significant differences between the LRH and ORH groups regarding 2-year disease-free survival rate or 2-year overall survival rate (P = 0.645 and P = 0.090, respectively).

Conclusions: Even in patients with cirrhosis, pure LRH is not less safe than the traditional open approach. The oncological outcomes of HCC were also comparable between the two groups. In selected patients, pure LRH for HCC appears to represent a viable alternative to ORH.

*Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Department of Surgery, Division of HBP Surgery and Liver Transplantation, Korea University Medical Center, Korea University Medical College, Seoul, Korea

Department of Surgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea

§Department of Surgery, Division of HBP Surgery and Liver Transplantation, Chosun University Medical Center, Chosun University Medical College, Gwangju, Korea.

Reprints: Ki-Hun Kim, MD, PhD, Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Poongnap-dong, Songpa-gu, Seoul, 138–736, Korea. E-mail: khkim620@amc.seoul.kr.

Disclosure: This study was not supported by any organizations. The authors declare no conflicts of interest.

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