Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease

Hypothesis: Laparoscopic liver resection for subcapsular hepatocellular carcinoma in patients with chronic liver disease is associated with lower morbidity than open resections. Design: A case-comparison study. Setting: A tertiary referral center. Patients and Intervention: From December 1, 1998, to November 30, 2000, 13 patients with chronic liver disease who under-went laparoscopic resection of hepatocellular carcinoma formed the laparoscopic group (LG). Tumors were 5 cm or smaller, subcapsular, and located in anterolateral segments (segments II-VI). A control group was created by matching each laparoscopic case with patients identical for liver disease, tumor size, and location and type of hepatectomy who underwent open liver resection. Fourteen patients fulfilled the criteria and formed the open group (OG). Main Outcome Measures: Postoperative mortality and morbidity. Results: One segment or less was resected in 21 patients and 2 in 6 patients. Operative duration and cumulative portal triad clamping times were longer in the LG (267 79 minutes vs 182 57 minutes, P=.006; 68 24 minutes vs 25 19 minutes, P=.006, respectively). Mortality rates were 0% in the LG and 14% (2/14) in the OG (P=.2). Postoperative liver failure and ascites occurred in 8% (1/13) in the LG and 36% (5/14) in the OG (P =.15). Surgical margin was not different in the 2 groups. Three-year survival was significantly higher in the LG (89% vs 55%; P=.04), but 3-year recurrence rates were similar (46% vs 44%). Conclusion: Our study suggests that, despite longer operative and clamping times without clinical consequences, the rate of decompensation of liver disease could be lower after laparoscopy.