M. Meguro1, T. Mizuguchi1, M. Kawamoto1, S. Ota1, M. Ishii1, T. Nishidate1, K. Okita1, Y. Kimura1, K. Hirata1 1Sapporo Medical University School Of Medicine,Department Of Surgery, Surgical Oncology And Science,Sapporo, HOKKAIDO, Japan
Introduction: Number of laparoscopic liver resection (LR) tends to be increasing in recent years. Although the short term safety in the LR was comparable to the classical open liver resection (OR), the long-term prognosis between LR and OR has not been elucidated yet. So, we retrospectively analyzed the patients who received liver resection consecutively and selected matching paired group among LR and OR after propensity score analysis. Aim of this study was to show any prognostic difference between LR and OR in the hepatocellular carcinoma (HCC) patients who received initial liver resection.
Methods: From January 2003 and June 2011, consecutive 260 HCC patients (LR: n=60 and OR: n=200) were enrolled in this study. Propensity scores were calculated for each patient in the two groups, using the following 10 covariate factors, such as age, gender, tumor size, number of tumors, vascular invasion, poor differentiation/non-poor differentiation, serum total bilirubin, serum albumin, PT, and ICGR15. One-to-one matching was carried out by propensity score analysis with Greedy method. The survival curves were compared by log-rank test using the Kaplan-Meier method.
Results: In the full analysis set (n = 260), patients of advanced age and female patients were significantly different between the groups. Tumor factors such as size, the number of tumors, vascular invasion, and the frequency of poor differentiation were significantly more favorable, the amount of bleeding during surgery was significantly lower, and operation time was significantly shorter in the Lap group. A recurrence-free survival rates (RFS) and postoperative overall survival rates (OS) in the LR (Fig. 1a and 1b) were significantly longer than in the OR (P = 0.048 and 0.004, respectively). After propensity score matching analysis, 35 each patient was selected and analyzed as matching set. The intraoperative bleeding in the LR was significantly lower than in the OR (p=0.002), although other clinical variables were generally consistent in the two groups. In addition, there was no significant difference (Fig. 1c and 1d) in the RFS and OS (P = 0.954 and 0.672, respectively).
Conclusions: When the prognoses of HCC patients after initial liver resection were compared between the LR and the OR after matching patient background factors, including tumor factors and liver function factors, no significant differences in RFS or OS were observed, demonstrating non-superiority of LR. Therefore, LR seems to offer comparable oncological curability to the classical OR in the long-term prognosis.
