Background

Laparoscopic liver resection (LLR) has evolved as a safe and effective alternative to conventional open liver resection (OLR) for malignant lesions. However, LLR in cirrhotic patients remains challenging. This study analyzed the perioperative and oncological outcomes of LLR for hepatocellular carcinoma (HCC) with cirrhosis compared with OLR using propensity score matching.

Methods

A multicenter retrospective analysis of records of patients who underwent limited liver resection for HCC and were histologically diagnosed with liver cirrhosis between January 2009 and December 2017 in the eight institutions belonging to the Hiroshima Surgical study group of Clinical Oncology was performed. The patients were divided into two groups: the LLR and OLR groups. After propensity score matching, we compared clinicopathological features and outcomes.

Results

In total 256 patients with histological liver cirrhosis who underwent limited liver resection for HCC were included in this study; 58 patients had undergone LLR, and the remaining 198 patients OLR. The number of tumors was higher, tumor size was larger, and difficulty score was significantly higher in the OLR group before propensity matching. After the matching, the data of the well-matched 58 patients in each group were evaluated; the intraoperative blood loss was lower in the LLR group (p = 0.004), and incidence of the postoperative complications was significantly higher in the OLR group (p = 0.019). The duration of the postoperative hospital stay was significantly shorter in the LLR group (p < 0.001). There were no differences between two groups in overall survival and recurrent-free survival.

Conclusions

LLR decreased the incidences of postoperative complications, shortened the duration of postoperative hospital stay. Thus, LLR is a safe and feasible procedure even in patients with cirrhosis.

中文翻译：

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腹腔镜与开放式有限肝切除术治疗肝硬化肝细胞癌的倾向评分与广岛外科临床肿瘤研究组（HiSCO）的匹配性研究

背景

腹腔镜肝切除术（LLR）已发展成为一种安全，有效的替代传统开放性肝切除术（OLR）的恶性病变。然而，肝硬化患者的LLR仍然具有挑战性。这项研究使用倾向性得分匹配分析法对与肝癌合并肝硬化的肝癌（HCC）和肝癌相比，LLR的围手术期和肿瘤学结局进行了分析。

方法

对广岛外科临床肿瘤学研究组的八家机构进行了多中心回顾性分析，分析了2009年1月至2017年12月之间进行了有限肝切除的HCC并在组织学上诊断为肝硬化的患者的记录。将患者分为两组：LLR和OLR组。倾向评分匹配后，我们比较了临床病理特征和结局。

结果

本研究共纳入256例因肝癌行有限肝切除术的组织学性肝硬化患者。58位患者接受了LLR，其余198位患者接受了LLR。在倾向匹配之前，OLR组的肿瘤数量更高，肿瘤更大，难度评分显着更高。匹配后，评估每组中匹配良好的58位患者的数据；LLR组的术中出血量较低（p  = 0.004），OLR组的术后并发症发生率明显较高（p  = 0.019）。LLR组术后住院时间显着缩短（p <0.001）。两组的总生存期和无复发生存期无差异。

结论

LLR降低了术后并发症的发生率，缩短了术后住院时间。因此，即使在肝硬化患者中，LLR也是一种安全可行的方法。