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Ten-Year Experience in a Single Center

Eric C. H. Lai, MB ChB, MRCSEd, FRACS; Chung Ngai Tang, MB BS, FRCS; Joe P. Y. Ha, MB BS, FRCS; Michael K. W. Li, MB BS, FRCS

Arch Surg. 2009;144(2):143-147.

Hypothesis  Laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma (HCC) have the same surgical outcome.

Design  Nonrandomized comparative study.

Setting  Tertiary referral center.

Patients  Twenty-five consecutive patients with HCC undergoing laparoscopic hepatectomy from January 1, 1998, through December 31, 2007, and a retrospective control group of 33 patients who underwent open hepatectomy for HCC during the same period. The 2 groups were matched in terms of demographic data, tumor size, and severity of cirrhosis.

Interventions  Laparoscopic hepatectomy.

Main Outcome Measures  Surgical morbidity rate, mortality rate, and survival.

Results  One patient in the laparoscopic group underwent conversion to an open approach. The median operating time and blood loss were 150 minutes and 200 mL, respectively. The resections were R0 in 22 patients (88%) and R1 in 3 (12%). The hospital mortality and morbidity rates were 0% and 16% (4 patients), respectively. The 3-year overall and disease-free survival rates were 60% and 52%, respectively. There was no difference in surgical morbidity rate, hospital mortality rate, and midterm survival results between the 2 groups. The laparoscopic approach resulted in a shorter hospital stay.

Conclusions  Laparoscopic hepatectomy for HCC is feasible and safe in selected patients. Midterm survival is also favorable. The laparoscopic approach has the benefit of a shorter hospital stay. However, the procedure should be performed by a surgical team expert in hepatobiliary and laparoscopic surgery in properly selected patients.

Author Affiliations: Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.

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