Original Article

J Minim Invasive Surg 2013; 16(2): 15-20

Published online June 15, 2013

https://doi.org/10.7602/jmis.2013.16.2.15

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

간세포암에 있어서 복강경 간절제술과 개복 간절제술의 단기 결과에 대한 비교 분석

이정연ㆍ노영훈ㆍ김영훈ㆍ최홍조

동아대학교병원 외과학교실

Received: September 23, 2012; Revised: May 12, 2013; Accepted: May 16, 2013

Analysis of the Short-term Result of Laparoscopic Liver Resection vs Open Liver Resection for Hepatocellular Carcinoma

Jung Yeon Lee, M.D., Young Hoon Roh, M.D., Ph.D., Young Hoon Kim, M.D., Ph.D., Hong Jo Choi, M.D., Ph.D.

Department of Surgery, Dong-A University of Medical Center, Busan, Korea

Correspondence to : Jung Yeon Lee
Department of Surgery, Dong-A University of Medical Center, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea
Tel:+82-51-240-5146, Fax:+82-51-247-9316 E-mail:koco26@hanmail.net

Received: September 23, 2012; Revised: May 12, 2013; Accepted: May 16, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery.

Methods: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively.

Results: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024).

Conclusion: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.

Keywords Hepatocellular carcinoma, Laparoscopic hepatectomy

  1. Luca A, Eleonora G, Carlo P, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol 2010;102:82-86.
    Pubmed CrossRef
  2. Azagra JS, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy - technical aspects. Surg Endosc 1996;10:758-761.
    Pubmed CrossRef
  3. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 2007;21:2004-2011.
    Pubmed CrossRef
  4. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190-194.
    Pubmed CrossRef
  5. Belli G, Limongelli P, Fantini C, et al. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 2009;96:1041-1048.
    Pubmed CrossRef
  6. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  7. Cherqui D, Laurent A, Tayar C, et al. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 2006;243:499-506.
    Pubmed KoreaMed CrossRef
  8. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 2001;234:63-70.
    Pubmed KoreaMed CrossRef
  9. Belghiti J, Regimbeau JM, Durand F, et al. Resection of hepatocellular carcinoma: a European experience on 328 cases. Hepatogastroenterol 2002;49:41-46.
  10. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009;250:825-830.
    Pubmed CrossRef
  11. Ergul E, Korukluoglu B. Peritoneal adhesions: facing the enemy. Int J Surg 2008;6:253-260.
    Pubmed CrossRef
  12. Senthilkumar MP, Dreyer JS. Peritoneal adhesions: pathogenesis, assessment and effects. Trop Gastroenterol 2006;27:11-18.
    Pubmed
  13. Ito K, Ito H, Are C, et al. Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 2009;13:2276-2283.
    Pubmed CrossRef
  14. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  15. Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 2009;19:e171-e174.
    Pubmed CrossRef
  16. Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005;242:252-259.
    Pubmed KoreaMed CrossRef
  17. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 2009;249:617-623.
    Pubmed CrossRef
  18. Haghighi KS, Wang F, King J, Daniel S, Morris DL. In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection. Am J Surg 2005;190:43-47.
    Pubmed CrossRef
  19. Yao P, Chu F, Daniel S, et al. A multicentre controlled study of the InLine radiofrequency ablation device for liver transection. HPB (Oxford) 2007;9:267-271.
    Pubmed KoreaMed CrossRef
  20. Spencer L, Metcalfe MS, Strickland AD, Elseg EJ, Robertson GS, Lloyd DM. Lessons from laparoscopic liver surgery: a nine year case series. HPB Surg 2008;2008:458137.
    Pubmed KoreaMed CrossRef
  21. Hompes D, Aerts R, Penninckx F, Topal B. Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 2007;21:175-180.
    Pubmed CrossRef
  22. Poon RLP, Fan ST, LinNg IO, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma. A critical reappraisal. Ann Surg 2000;231:544-551.
    Pubmed KoreaMed CrossRef
  23. Kazaryan AM, Marangos IP, Rosseland AR, et al. Laparoscopic liver resection for malignant and benign lesions. Arch Surg 2004;145:34-40.
  24. Masuda T, Beppu T, Ishiko T, et al. Intrahepatic dissemination of hepatocellular carcinoma after local ablation therary. J Hepatobiliary Pancreat Surg 2008;15:589-595.
    Pubmed CrossRef
  25. Ng KK, Poon RT, Lo CM, Yuen J, Tso WK, Fan ST. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 2008;12:183-191.
    Pubmed CrossRef
  26. Schaeff B, Paolucci V, Thomopoulos J. Port site recurrences after laparoscopic surgery. A review. Dig Surg 1998;15:124-134.
    Pubmed CrossRef
  27. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  28. Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 2008;22:2350-2356.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2013; 16(2): 15-20

Published online June 15, 2013 https://doi.org/10.7602/jmis.2013.16.2.15

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

간세포암에 있어서 복강경 간절제술과 개복 간절제술의 단기 결과에 대한 비교 분석

이정연ㆍ노영훈ㆍ김영훈ㆍ최홍조

동아대학교병원 외과학교실

Received: September 23, 2012; Revised: May 12, 2013; Accepted: May 16, 2013

Analysis of the Short-term Result of Laparoscopic Liver Resection vs Open Liver Resection for Hepatocellular Carcinoma

Jung Yeon Lee, M.D., Young Hoon Roh, M.D., Ph.D., Young Hoon Kim, M.D., Ph.D., Hong Jo Choi, M.D., Ph.D.

Department of Surgery, Dong-A University of Medical Center, Busan, Korea

Correspondence to:Jung Yeon Lee
Department of Surgery, Dong-A University of Medical Center, 3-1, Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea
Tel:+82-51-240-5146, Fax:+82-51-247-9316 E-mail:koco26@hanmail.net

Received: September 23, 2012; Revised: May 12, 2013; Accepted: May 16, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Laparoscopic surgery has recently shown rapid development, and has been applied in most abdominal surgeries. It has also been adopted in hepatobiliary surgery, especially in the resection of liver tumors. Significant advantages of laparosopic surgery over the conventional open method have been reported, however, the safety of the surgical resection margin and radicality of the tumor resection remain to be clarified. This study was conducted in order to assess the feasibility and potential superiority of laparoscopic liver resection of hepatocellular tumors to open surgery.

Methods: This study included 76 patients who underwent liver resection for hepatocellular carcinoma at Dong-A University Hospital from January 2008 through June 2010. Of these 63 cases, 31 patients underwent laparoscopic resections and 33 underwent open liver resections. Both groups were confirmed as hepatocellular carcinoma by postoperative pathology and analyzed retrospectively.

Results: There were no statistically significant differences in preoperative parameters, such as age, height, body weight, Child Pugh score, ASA, and tumor size in both groups. There were no significant differences in operating time, duration of hospital stay, safety margins of surgical resection, postoperative complications, and rate of recurrence and occurrence of new lesions in both groups, however, better disease free survival was observed in the laparoscopic group (p=0.024).

Conclusion: Findings of this study showed that the laparoscopic group had better results in free survival period than the open group. Conduct of larger scale prospective studies wound confirm the superiority of the laparoscopic liver resection to the conventional open procedure in patients with hepatocellular carcinoma. Findings of this study also suggest that assessment of the factors associated with the quality of life, such as degree of postoperative pain, and size of the incisional scar, and long term postoperative complications may play an additional role in favoring the laparoscopic liver resection. To elucidate the superiority of the laparoscopic liver resection to the conventional open method, conduct of study involving a larger study group and a longer prospective research period will be needed.

Keywords: Hepatocellular carcinoma, Laparoscopic hepatectomy

References

  1. Luca A, Eleonora G, Carlo P, et al. Case-matched analysis of totally laparoscopic versus open liver resection for HCC:short and middle term results. J Surg Oncol 2010;102:82-86.
    Pubmed CrossRef
  2. Azagra JS, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy - technical aspects. Surg Endosc 1996;10:758-761.
    Pubmed CrossRef
  3. Belli G, Fantini C, D’Agostino A, et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 2007;21:2004-2011.
    Pubmed CrossRef
  4. Kaneko H, Takagi S, Otsuka Y, et al. Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190-194.
    Pubmed CrossRef
  5. Belli G, Limongelli P, Fantini C, et al. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 2009;96:1041-1048.
    Pubmed CrossRef
  6. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  7. Cherqui D, Laurent A, Tayar C, et al. Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 2006;243:499-506.
    Pubmed KoreaMed CrossRef
  8. Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 2001;234:63-70.
    Pubmed KoreaMed CrossRef
  9. Belghiti J, Regimbeau JM, Durand F, et al. Resection of hepatocellular carcinoma: a European experience on 328 cases. Hepatogastroenterol 2002;49:41-46.
  10. Buell JF, Cherqui D, Geller DA, et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 2009;250:825-830.
    Pubmed CrossRef
  11. Ergul E, Korukluoglu B. Peritoneal adhesions: facing the enemy. Int J Surg 2008;6:253-260.
    Pubmed CrossRef
  12. Senthilkumar MP, Dreyer JS. Peritoneal adhesions: pathogenesis, assessment and effects. Trop Gastroenterol 2006;27:11-18.
    Pubmed
  13. Ito K, Ito H, Are C, et al. Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 2009;13:2276-2283.
    Pubmed CrossRef
  14. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  15. Endo Y, Ohta M, Sasaki A, et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma. Surg Laparosc Endosc Percutan Tech 2009;19:e171-e174.
    Pubmed CrossRef
  16. Hasegawa K, Kokudo N, Imamura H, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005;242:252-259.
    Pubmed KoreaMed CrossRef
  17. Katz SC, Shia J, Liau KH, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 2009;249:617-623.
    Pubmed CrossRef
  18. Haghighi KS, Wang F, King J, Daniel S, Morris DL. In-line radiofrequency ablation to minimize blood loss in hepatic parenchymal transection. Am J Surg 2005;190:43-47.
    Pubmed CrossRef
  19. Yao P, Chu F, Daniel S, et al. A multicentre controlled study of the InLine radiofrequency ablation device for liver transection. HPB (Oxford) 2007;9:267-271.
    Pubmed KoreaMed CrossRef
  20. Spencer L, Metcalfe MS, Strickland AD, Elseg EJ, Robertson GS, Lloyd DM. Lessons from laparoscopic liver surgery: a nine year case series. HPB Surg 2008;2008:458137.
    Pubmed KoreaMed CrossRef
  21. Hompes D, Aerts R, Penninckx F, Topal B. Laparoscopic liver resection using radiofrequency coagulation. Surg Endosc 2007;21:175-180.
    Pubmed CrossRef
  22. Poon RLP, Fan ST, LinNg IO, Wong J. Significance of resection margin in hepatectomy for hepatocellular carcinoma. A critical reappraisal. Ann Surg 2000;231:544-551.
    Pubmed KoreaMed CrossRef
  23. Kazaryan AM, Marangos IP, Rosseland AR, et al. Laparoscopic liver resection for malignant and benign lesions. Arch Surg 2004;145:34-40.
  24. Masuda T, Beppu T, Ishiko T, et al. Intrahepatic dissemination of hepatocellular carcinoma after local ablation therary. J Hepatobiliary Pancreat Surg 2008;15:589-595.
    Pubmed CrossRef
  25. Ng KK, Poon RT, Lo CM, Yuen J, Tso WK, Fan ST. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg 2008;12:183-191.
    Pubmed CrossRef
  26. Schaeff B, Paolucci V, Thomopoulos J. Port site recurrences after laparoscopic surgery. A review. Dig Surg 1998;15:124-134.
    Pubmed CrossRef
  27. Tranchart H, Di Giuro G, Lainas P, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 2010;24:1170-1176.
    Pubmed CrossRef
  28. Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 2008;22:2350-2356.
    Pubmed CrossRef

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