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Laparoscopic Anatomical Versus Non-Anatomical Liver Resection for Hepatocellular Carcinoma in the Posterosuperior Segments: A Propensity Score Matched Analysis
26 Pages Posted: 8 Jul 2021
More...Abstract
Background: The role of laparoscopic non-anatomical resection (LNAR) for tumors located in the posterosuperior (PS) segments of the liver (segments 1, 4a, 7, and 8) remains unclear. We sought to compare the short- and long-term outcomes of laparoscopic anatomical resection (LAR) and LNAR for hepatocellular carcinoma (HCC) located in the PS segments.
Methods: We retrospectively reviewed the data for 1029 patients who underwent hepatectomy for HCC between January 2004 and December 2018 at a single tertiary hospital. Of 167 patients who underwent LLR for HCC in PS segments, 64 underwent LNAR and 103 underwent LAR. Patient were matched one-to-one using propensity score matching (46:46).
Findings: LNAR was associated with significantly shorter operation time ( P =0.001), lower estimated blood loss (P =0.001), lower transfusion rate (P =0.006) and shorter hospital stay (P =0.012) than LAR. The respective 1-, 3-, and 5-year overall survival rates (LAR: 95.3, 87.1, and 77.8%; LNAR: 96.7, 91.6, and 85.0%; P =0.262) and recurrence-free survival rates (LAR: 75.7, 70.3, and 68.9%; LNAR: 81.8, 58.3, and 55.3%; P =0.897) were similar in both groups. Recurrence was mostly intrahepatic in the LNAR group and extrahepatic in the LAR group (P =0.023). Post-recurrence treatments differed significantly between the two groups (P =0.016); the re-resection rate was much greater in the LNAR group (45.0% vs. 0%) group. The respective 1-, 3-, and 5-year survival after recurrence rates were similar in the LAR (78.3%, 49.0%, and 49.0%) and LNAR (92.3%, 79.1%, and 59.3%) groups (P =0.212).
Interpretation: LNAR is safe and feasible for HCC located in PS segments, and provided better short-term outcomes than LAR and acceptable oncological outcomes.
Funding: None to declare.
Declaration of Interest: None to declare.
Ethical Approval: In accordance with guidelines for human subjects’ research, this retrospective study was approved by the study was approved by the institutional review board of Seoul National University Bundang Hospital, Seongnam, Korea, an academic hospital affiliated to Seoul National University, College of Medicine (Approval No. B-2021-633).
Keywords: Laparoscopy; Hepatectomy; Carcinoma, Hepatocellular; Recurrence
Suggested Citation: Suggested Citation