Comparison between laparoscopic liver resection and open liver resection in patients with hepatocellular carcinoma with portal vein tumor thrombosis

초록

Background Recently, the outcomes of surgical treatment for advanced hepatocellular carcinoma (HCC) have improved. However, despite the technical advancements in laparoscopic liver resection (LLR), it is still not recommended as the standard treatment for HCC with portal vein tumor thrombosis (PVTT) because of the poor oncological outcomes. This study aims to compare the clinical outcomes of open liver resection (OLR) and LLR in patients with HCC with PVTT. Methods A total of 86 patients with PVTT confrmed in the pathological report between January 2014 and December 2018, were enrolled. Short-term, postoperative, and long-term outcomes, including recurrence-free survival and overall survival rates, were evaluated. Results No diference between the two groups, except for age, was detected. The median age in the laparoscopic group was signifcantly higher than that in the open group. Regarding the pathological features, the maximal tumor size was signifcantly larger in the OLR; other pathological factors did not difer. There was no signifcant diference between overall survival (OS) and recurrence-free survival (RFS). Vp3 PVTT (hazards ratio [HR] 6.1, 95% confdence interval [CI] 1.9–18.5), Edmondson grade IV (HR 4.7, 95% CI 1.7–12.9, p=0.003), and intrahepatic metastasis (HR 3.9, 95% CI 2.1–7.2, p<0.001) remained the unique independent predictors of recurrence-free survival according to a multivariate Cox proportional hazard regression analysis. Conclusions Laparoscopic liver resection for the management of HCC with PVTT provides the same short- and long-term results as those of the open approach.

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