Comparative study and systematic review of laparoscopic liver resection for hepatocellular carcinoma

Table 1 Preoperative characteristics n (%)

Variable	LLR (n = 42)	OLR (n = 110)	P value
Age	61.07 (11.91)	59.45 (11.15)	0.400
Gender			0.359
Male	32 (76.2)	91 (82.7)
Female	10 (23.8)	19 (17.3)
Child-Pugh score			0.094
A	42 (100.0)	103 (93.6)
B	0 (0.0)	7 (6.4)
No. of comorbidities	3 ± 1.86	2.32 ± 1.64	0.028
HBsAg	6 (42.9)	25 (55.6)	0.406
Anti-HCV	1 (7.1)	1 (2.7)	0.466
Alpha-fetoprotein	734.33 ± 2978.62	2126.96 ± 8456.88	0.654
ALT	40.64 ± 28.86	46.57 ± 35.59	0.408
AST	46.83 ± 36.03	56.93 ± 50.26	0.280
ALP	90.26 ± 35.51	102.29 ± 44.24	0.099
Total bilirubin	13.12 ± 7.18	12.91 ± 14.26	0.367
PT	13.71 ± 0.94	13.61 ± 1.64	0.176
ASA class			0.045
I	3 (7.1)	9 (8.2)
II	24 (57.1)	62 (56.4)
III	15 (35.7)	39 (35.5)
No. of tumours			0.469
Solitary	37 (88.1)	91 (82.7)
Multiple	5 (11.9)	19 (17.3)
Size of largest tumour (cm)	3.85 ± 2.60	7.15 ± 4.88	< 0.001
Tumour location			0.256
Left lobe	15 (35.7)	27 (24.5)
Right lobe	21 (50.0)	71 (64.5)
Bilobar	6 (14.3)	12 (10.9)

Data are mean ± SD or n (%) unless otherwise indicated. HBsAg: Hepatitis B virus surface antigen; Anti-HCV: Anti-hepatitis C virus antibody; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; PT: Prothrombin time; ASA: American Society of Anaesthesiologists; LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 2 Perioperative data n (%)

Variable	LLR (n = 42)	OLR (n = 110)	P value
Type of resection			< 0.001
Right hepatectomy	4 (9.5)	33 (30.0)
Left hepatectomy	4 (9.5)	11 (10.0)
Extended right hepatectomy	0 (0.0)	9 (8.2)
Extended left hepatectomy	0 (0.0)	6 (5.5)
Right anterior sectionectomy	0 (0.0)	2 (1.8)
Right posterior sectionectomy	6 (14.3)	2 (1.8)
Left lateral sectionectomy	8 (19.0)	3 (2.7)
Wedge resection	6 (14.3)	10 (9.1)
Segmentectomy	14 (33.3)	31 (28.2)
Others	0 (0.0)	3 (2.7)
Conversion from LLR to OLR	5 (11.9)	-	-
Duration of operation (min), means ± SD	250.43 ± 98.85	349.90 ± 132.29	< 0.001
Intra-operative blood loss (mL), mean ± SD	495.83 ± 501.94	1085.00 ± 943.55	< 0.001
Blood transfusion	4 (9.5)	43 (39.1)	< 0.001
Amount transfused (mL), mean ± SD	709.25 ± 726.18	1349.30 ± 1532.32	0.269

LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 3 Pathologic results n (%)

Variable	LLR (n = 42)	OLR (n = 110)	P value
Condition of non-tumourous liver
Normal	8 (19.0)	35 (31.8)	0.118
Chronic hepatitis	12 (28.6)	31 (28.2)	0.962
Cirrhosis	25 (59.5)	39 (35.5)	0.007
Steatosis	16 (38.1)	29 (26.4)	0.157
Others	2 (4.8)	5 (4.5)	0.955
Microscopic vascular invasion	6 (14.3)	34 (30.9)	0.037
Invasion into adjacent organs	0 (0.00)	2 (1.8)	0.379
Histological grade			0.077
Well differentiated	9 (21.4)	20 (18.2)
Moderately differentiated	30 (71.4)	61 (55.5)
Poorly differentiated	3 (7.1)	28 (25.5)
Undifferentiated	0 (0.0)	1 (0.9)
Positive resection margin	1 (2.4)	8 (7.3)	0.253

LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 4 Postoperative outcomes n (%)

Variable	LLR (n = 42)	OLR (n = 110)	P value
Patients with complications	16 (38.1)	50 (45.5)	0.413
Bleeding	1 (2.4)	1 (0.9)	0.476
Prolonged ascites	1 (2.4)	4 (3.6)	0.698
Intra-abdominal sepsis	0 (0.0)	3 (2.7)	0.280
Liver failure	2 (4.8)	1 (0.9)	0.127
Cardiac	3 (7.1)	10 (9.1)	0.701
Pulmonary	8 (19.0)	15 (13.6)	0.405
Gastrointestinal	1 (2.4)	9 (8.2)	0.197
Wound infections	0 (0.0)	5 (3.3)	0.160
Postoperative mortality	1 (2.4)	3 (2.7)	0.905
Length of hospital stay (d), means ± SD	7.55 ± 11.74	11.42 ± 9.35	< 0.001

LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 5 Oncological outcomes

Variable	LLR (n = 42)	OLR (n = 110)	P value
Overall survival time (mo), mean ± SD	71.25 ± 6.59	76.42 ± 4.468	0.949
Disease-free survival time (mo), mean ± SD	46.81 ± 7.132	34.390 ± 4.254	0.035

LLR: Laparoscopic liver resection; OLR: Open liver resection.

Table 6 Characteristics of included studies

Ref.	No. of patients		Child-Pugh score A			Solitary tumour			Mean tumour size (cm)
	LLR	OLR	LLR n (%)	OLR n (%)	P value	LLR n (%)	OLR n (%)	P value	LLR	OLR	P value
Shimada et al[10]	17	38	-	-	-	-	-	-	2.6 ± 0.9	2.5 ± 1.0	0.89
Laurent et al[11]	13	14	13 (100.0)	14 (100.0)	0.49	-	-	-	3.35 ± 0.89	3.43 ± 1.05	0.48
Kaneko et al[12]	30	28	22 (73.3)	22 (57.9)	NS	-	-	-	3.0 ± 0.8	3.1 ± 0.9	NS
Sarpel et al[13]	20	56	-	-	-	-	-	-	4.3 ± 2.1	4.3 ± 2.2	0.876
Lai et al[14]	25	33	23 (92.0)	31 (93.9)	0.90
Belli et al[15]	54	125	49 (90.7)	117 (93.6)	0.499	44 (81.5)	96 (76.8)	0.486	3.8 ± 1.3	6.0 ± 2.3	0.006
Endo et al[16]	10	11	10 (100.0)	7 (63.6)	NS	9 (90.0)	10 (90.9)	NS	3.0 ± 1.5	4.1 ± 0.8	NS
Aldrighetti et al[17]	16	16	9 (56.2)	9 (56.2)	NS	-	-	-	4 ± 2.2	4.6 ± 2.5	NS
Tranchart et al[18]	42	42	30 (71.4)	33 (78.6)	-	-	-	-	3.58 ± 1.75	3.68 ± 2.09	0.95
Ker et al[19]	116	209	98 (84.5)	197 (94.3)	0.08	-	-	-	2.5 ± 1.2	5.4 ± 3.5	0.001
Kim et al[20]	26	29	-	-	-	-	-	-	-	-	-
Truant et al[21]	36	53	32 (88.9)	47 (88.7)	1	34 (94.4)	44 (83.0)	0.2	2.9 ± 1.2	3.1 ± 1.2	0.5
Hu et al[22]	30	30	29 (96.7)	24 (80.0)	NS	-	-	-	6.7 ± 3.1	8.7 ± 2.3	NS
Lee et al[23]	33	50	33 (100.0)	50 (100.0)	NS	31 (93.9)	41 (82.0)	0.186	-	-	-
Cheung et al[24]	32	64	32 (100.0)	60 (93.8)	0.367	-	-	-	-	-	-
Kim et al[25]	70	76	-	-	-	-	-	-	2.58 ± 1.44	2.45 ± 1.27	0.550
Kim et al[26]	29	29	28 (96.6)	29 (100.0)	0.317	24 (82.8)	28 (96.6)	0.103	3.59 ± 2.17	4.28 ± 2.55	0.278
Our reports	42	110	42 (100.0)	103 (93.6)	0.094	37 (88.1)	91 (82.7)	0.469	3.85 ± 2.60	7.15 ± 4.88	< 0.001

LLR: Laparoscopic liver resection; OLR: Open liver resection.