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Alexis Laurent, MD; Daniel Cherqui, MD; Mickael Lesurtel, MD; Francesco Brunetti, MD; Claude Tayar, MD; Pierre-Louis Fagniez, MD

Arch Surg. 2003;138:763-769.

Hypothesis  Laparoscopic liver resection for subcapsular hepatocellular carcinoma in patients with chronic liver disease is associated with lower morbidity than open resections.

Design  A case-comparison study.

Setting  A tertiary referral center.

Patients and Intervention  From December 1, 1998, to November 30, 2000, 13 patients with chronic liver disease who underwent laparoscopic resection of hepatocellular carcinoma formed the laparoscopic group (LG). Tumors were 5 cm or smaller, subcapsular, and located in anterolateral segments (segments II-VI). A control group was created by matching each laparoscopic case with patients identical for liver disease, tumor size, and location and type of hepatectomy who underwent open liver resection. Fourteen patients fulfilled the criteria and formed the open group (OG).

Main Outcome Measures  Postoperative mortality and morbidity.

Results  One segment or less was resected in 21 patients and 2 in 6 patients. Operative duration and cumulative portal triad clamping times were longer in the LG (267 ± 79 minutes vs 182 ± 57 minutes, P = .006; 68 ± 24 minutes vs 25 ± 19 minutes, P = .006, respectively). Mortality rates were 0% in the LG and 14% (2/14) in the OG (P = .2). Postoperative liver failure and ascites occurred in 8% (1/13) in the LG and 36% (5/14) in the OG (P = .15). Surgical margin was not different in the 2 groups. Three-year survival was significantly higher in the LG (89% vs 55%; P = .04), but 3-year recurrence rates were similar (46% vs 44%).

Conclusion  Our study suggests that, despite longer operative and clamping times without clinical consequences, the rate of decompensation of liver disease could be lower after laparoscopy.

From the Department of Digestive Surgery, Hospital Henri Mondor, University Paris 12, Creteil, France.

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