Comparison of outcomes between laparoscopic vs. open liver resection for intermediate stage hepatocellular carcinoma

Aim: The Barcelona Clinic Liver Score (BCLC) currently limits hepatic resection only for small, solitary tumors measuring 2-3 cm with no signs of portal hypertension (PHT) or macrovascular invasion. The aim of this study was to show the benefit of surgical resection, and to compare the peri-operative and long-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC) classified as intermediate stage (B) under BCLC.Methods: From 2004 to 2013, 49 patients staged as intermediate (BCLC B) and who underwent hepatic resection was included. These patients were divided into LLR or OLR. Demographics, tumor characteristics, recurrence rates and overall survival (OS) were compared between the 2 groups.Results: Forty-nine patients were included and grouped into LLR (n = 28) and OLR (n = 21). The average tumor number was 2 ± 1 for both groups, while the mean tumor size was 4.4 ± 1.7 cm and 5.3 ± 2.6 cm for the LLR and OLR group, respectively. When compared with OLR, LLR had lower post-operative complications (14.3% vs. 33.3%, P = 0.114), and a statistically significant shorter hospital stay than the OLR group (9 vs. 21 days, P = 0.023). The LLR group also achieved a statistically significant difference in complete R0 resection as compared with the OLR group (P = 0.016). The OS and disease-free survival (DFS) at 1, 3 and 5 years were comparable between LLR and OLR (OS: 89.1% vs. 76.2%; 70.4% vs. 55.9%; 58.6% vs. 43.5%, P = 0.583; DFS: 59.3% vs. 51.0%; 20.2% vs. 44.6%; 16.2% vs. 37.2%, P = 0.947, respectively).Conclusion: LLR showed comparable outcomes compared to OLR in the treatment of HCC staged BCLC B. Therefore, LLR as well as OLR can be considered in selective patients in the BCLC B group