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Laparoscopic hepatectomy enhances recovery for small hepatocellular carcinoma with liver cirrhosis by postoperative inflammatory response attenuation: a propensity score matching analysis with a conventional open approach

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Abstract

Background

The concurrent presence of liver cirrhosis and hepatocellular carcinoma (HCC) poses a challenge for laparoscopic surgeons to establish a routine practice. The aim of this study was to gather evidence and produce recommendations on the safe and effective practice of laparoscopic hepatectomy for patients with solitary HCC (≤ 5 cm) and liver cirrhosis.

Methods

Between October 2013 and October 2014, 356 curative hepatectomies were performed for patients pathologically diagnosed with solitary HCC (≤ 5 cm) accompanied by cirrhosis (stage 4 fibrosis). To overcome selection bias, a 1:2 match using propensity score matching analysis was conducted between laparoscopic and open hepatectomy. Perioperative outcomes were compared between the groups, including hospitalization, operation time, blood loss, and surgical complications. Perioperative inflammation-based markers, including systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were collected from medical records and analyzed.

Results

There were 43 and 77 patients in the laparoscopic and open groups, respectively. The laparoscopic group had less hepatic inflow occlusion (16.3% vs. 61%; P < 0.001), shorter operation time (155 vs. 170 min; P = 0.004), and shorter postoperative hospital stay (4 vs. 7 days; P < 0.001). Although the difference was not significant (P = 0.154), the rate of postoperative complications tended to be lower in the laparoscopic group (2.3%) compared with the open group (9.1%). The increase in postoperative SII, NLR, and LMR for laparoscopic hepatectomy were significantly lower than for open hepatectomy. NLR < 5.8 on postoperative day 3 was significantly correlated with shorter hospital stay (P < 0.001).

Conclusions

Compared with open hepatectomy, laparoscopic hepatectomy for selected HCC patients, even in the presence of cirrhosis, might result in better perioperative outcomes and postoperative inflammatory response attenuation, and ultimately promote faster recovery. This provides evidence for considering routine laparoscopic hepatectomy through careful selection of patients with HCC.

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Acknowledgements

We thank International Science Editing (https://www.internationalscienceediting.com) for editing this manuscript.

Funding

This study was funded by the National Natural Science Foundation of China (Grants No. 81972229), Youth Program of Zhongshan Hospital (2019ZSYQ07), Elites Program of Zhongshan Hospital (2019ZSGG03).

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Author notes

  1. **u-Tao Fu, Zheng Tang, and Jia-Feng Chen have contributed equally as first authors.

Authors and Affiliations

  1. Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 1609 **etu Road, Shanghai, 200032, China

    **u-Tao Fu, Zheng Tang, Jia-Feng Chen, Ying-Hong Shi, Wei-Ren Liu, Qiang Gao, Guang-Yu Ding, Kang Song, **ao-Ying Wang, Jian Zhou, Jia Fan & Zhen-Bin Ding

  2. Key Laboratory for Carcinogenesis and Cancer Invasion, Chinese Ministry of Education, Shanghai, China

    Jian Zhou & Jia Fan

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  1. **u-Tao Fu
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Correspondence to **ao-Ying Wang, Jia Fan or Zhen-Bin Ding.

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**u-Tao Fu, Zheng Tang, Jia-Feng Chen, Ying-Hong Shi, Jian Zhou, Wei-Ren Liu, Qiang Gao, Guang-Yu Ding, Kang Song, **ao-Ying Wang, Jia Fan and Zhen-Bin Ding have no conflicts of interest or financial ties to disclose.

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Fu, XT., Tang, Z., Chen, JF. et al. Laparoscopic hepatectomy enhances recovery for small hepatocellular carcinoma with liver cirrhosis by postoperative inflammatory response attenuation: a propensity score matching analysis with a conventional open approach. Surg Endosc 35, 910–920 (2021). https://doi.org/10.1007/s00464-020-07710-5

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