Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2765
Peer-review started: March 26, 2015
First decision: May 13, 2015
Revised: September 22, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: November 28, 2015
AIM: To compare the surgical outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) as a curative treatment in patients with hepatocellular carcinoma (HCC).
METHODS: A PubMed database search was performed systematically to identify comparative studies of LLR vs OLR for HCC from 2000 to 2014. An extensive text word search was conducted, using combinations of search headings such as “laparoscopy”, “hepatectomy”, and “hepatocellular carcinoma”. A comparative study was also performed in our institution where we analysed surgical outcomes of 152 patients who underwent liver resection between January 2005 to December 2012, of which 42 underwent laparoscopic or hand-assisted laparoscopic resection and 110 underwent open resection.
RESULTS: Analysis of our own series and a review of 17 high-quality studies showed that LLR was superior to OLR in terms of short-term outcomes, as patients in the laparoscopic arm were found to have less intraoperative blood loss, less blood transfusions, and a shorter length of hospital stay. In our own series, both LLR and OLR groups were found to have similar overall survival (OS) rates, but disease-free survival (DFS) rates were higher in the laparoscopic arm.
CONCLUSION: LLR is associated with better short-term outcomes compared to OLR as a curative treatment for HCC. Long-term oncologic outcomes with regards to OS and DFS rates were found to be comparable in both groups. LLR is hence a safe and viable option for curative resection of HCC.
Core tip: Surgical resection is the standard treatment for hepatocellular carcinoma (HCC), and provides the best outcomes for patients eligible for resection. Laparoscopic liver resection (LLR) is a relatively new advancement in treatment of HCC and has raised concerns on its feasibility and safety. We reviewed 17 studies and performed our own comparative study on surgical outcomes of LLR vs open liver resection for the curative treatment of HCC. We showed that LLR resulted in more desirable short-term outcomes, whereas long-term oncologic outcomes were comparable. Hence, LLR is a safe and feasible option in the surgical treatment of HCC.