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Perioperative and long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with well-preserved liver function and cirrhotic background: a propensity score matching study

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Abstract

Background

Although laparoscopic liver resection (LLR) has advanced into a safe and effective alternative to conventional open liver resection (OLR), it has not been widely accepted by surgeons. This article aimed to investigate the perioperative and long-term benefits of LLR versus OLR for hepatocellular carcinoma (HCC) in selected patients with well-preserved liver function and cirrhotic background.

Methods

A retrospective study was conducted on 1085 patients with HCC who underwent liver resection at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from July 2010 to July 2015, and 346 patients with well-preserved liver function and cirrhotic background were selected. A 1:1 propensity score matching (PSM), which is the best option to overcome selection bias, was conducted to compare the surgical outcomes and long-term prognosis between LLR and OLR. After PSM, a logistic regression analysis was used to identify the predictive risk factors of posthepatectomy liver failure (PHLF).

Results

By using PSM, the two groups were well balanced with 86 patients in each group. In the LLR group, only the median operation time was significantly longer than the OLR group, but the hospital stay, overall morbidity, and the incidence of PHLF were significantly decreased compared to OLR. There were no significant differences in the overall survival and disease-free survival rates between the two groups. On multivariate analysis, OLR was identified to be the only independent risk factor for PHLF.

Conclusions

In selected HCC patients with well-preserved liver function and cirrhotic background, LLR could be a better option compared to OLR.

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Acknowledgements

We really appreciate Wan Yee Lau, the former chairman of IHBPA, for his useful guidance and suggestion. This work was supported by the National Natural Science Foundation of China (Grant No. 81372562).

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Authors and Affiliations

  1. Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People’s Republic of China

    **nqiang Wu, Zejian Huang, Wan Yee Lau, Wenda Li, Pai Lin, Lei Zhang & Ya** Chen

  2. Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, People’s Republic of China

    Wan Yee Lau

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  1. **nqiang Wu
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  2. Zejian Huang
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Correspondence to Lei Zhang or Ya** Chen.

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Drs. **nqiang Wu, Lei Zhang, Zejian Huang, Won Yee Lau, Wenda Li, Pai Lin, and Ya** Chen have no conflicts of interest or financial ties to disclose.

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Wu, X., Huang, Z., Lau, W.Y. et al. Perioperative and long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with well-preserved liver function and cirrhotic background: a propensity score matching study. Surg Endosc 33, 206–215 (2019). https://doi.org/10.1007/s00464-018-6296-8

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