• Annals of surgery · May 2017

    Comparative Study

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

    • Young-In Yoon, Ki-Hun Kim, Sung-Hwa Kang, Wan-Joon Kim, Min-Ho Shin, Sang-Kyung Lee, Dong-Hwan Jung, Gil-Chun Park, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Shin Hwang, and Sung-Gyu Lee.
    • *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.
    • Ann. Surg. 2017 May 1; 265 (5): 856-863.

    ObjectiveWe 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.BackgroundLaparoscopic 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.MethodsWe 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.ResultsThere 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).ConclusionsEven 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.

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