Laparoscopic Versus Open Hepatic Resection for Solitary Hepatocellular Carcinoma Less Than 5cm in Cirrhotic Patients: A Randomized Controlled Study

Background: Current literature is lacking level 1 evidence for surgical and oncologic outcomes of hepatocellular carcinoma (HCC) undergoing laparoscopic versus open hepatectomy. Aim was to compare feasibility, safety, and surgical and oncologic efficiency of laparoscopic versus open liver resection (OLR) in management of solitary small (<5cm) peripheral HCC in Child A cirrhotic patients. Methods: Patients were randomly assigned to either OLR group (25 patients) or laparoscopic liver resection (LRR) group (LRR: 25 patients). All were treated with curative intent aiming at achieving R0 resection using radiofrequency-assisted technique. Results: LLR had significantly less operative time (120.3221.58 versus 146.80 +/- 16.59 minutes, P<.001) and shorter duration of hospital stay (2.40 +/- 0.58 versus 4.28 +/- 0.79 days, P<.001), with comparable overall complications (25 versus 28%, P=.02). LLR had comparative resection time (66.56 +/- 23.80 versus 59.56 +/- 14.74 minutes, P=.218), amount of blood loss (250 versus 230mL, P=.915), transfusion rate (P=1.00), and R0 resection rate when compared with OLR. After median follow-up of 34.43 (31.67-38.60) months, LLR achieved similar adequate oncological outcome of OLR, no local recurrence, with no significant difference in early recurrence or number of de novo lesions (P=.49). One-year and 3-year disease free survival (DFS) rates, 88% and 59%, in the LLR were comparable to corresponding rates of 84% and 54% in OLR (P=.9). Conclusion: LLR is superior to the OLR with significantly shorter duration of hospital stay and does not compromise the oncological outcomes.