Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma

BackgroundThe safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) with a diameter of 5cm or less is well recognized. The role of laparoscopy in treating large HCC (5-10cm) remains controversial. This prospective cohort study was undertaken to assess the short- and long-term outcomes of laparoscopic hepatectomy for large HCC and to compare this approach with open hepatectomy. MethodsPatients with a solitary HCC (diameter 5-10cm) who underwent open or laparoscopic hepatectomy were enrolled in a prospective observational study from January 2012 to April 2015. Perioperative and follow-up data were analysed. ResultsSome 128 patients underwent laparoscopic hepatectomy and 207 had an open hepatectomy. One and two perioperative deaths were reported in the laparoscopic and open groups respectively. Laparoscopic hepatectomy was converted to an open procedure in 12 (94 per cent) of 128 patients. More patients in the laparoscopic group underwent an anatomical hepatectomy than in the open group (453 versus 217 per cent; P=0001). The postoperative complication rate was 203 per cent for the laparoscopic group versus 357 per cent for the open group (P=0003). Mean(s.d.) duration of hospital stay was 114(31) and 158(77) days respectively (P<0001). One- and 3-year overall survival rates in the laparoscopic and open groups were 944 versus 936 per cent (P=0875), and 814 versus 822 per cent (P=0802), respectively. One- and 3-year disease-free survival rates were 894 versus 887 per cent (P=0825), and 673 versus 667 per cent (P=0902), respectively. ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of patients with large HCC.