Laparoscopic Anatomical Versus Non-anatomical hepatectomy in the Treatment of Hepatocellular Carcinoma: A randomised controlled trial. (June 2022)

• Record Type: Journal Article
• Authors: Liao, Kexi; Yang, Kaijin; Cao, Li; Lu, Yao; Zheng, Bowen; Li, Xuesong; Wang, Xiaojun; Li, Jianwei; Chen, Jian; Zheng, Shuguo
• Is Part Of: International journal of surgery. Volume 102(2022)
• Publication Date: 2022-06
• Subjects: Laparoscopic -- Anatomical hepatectomy -- Hepatocellular carcinoma -- Disease-free survival -- Overall survival; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2022.106652
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: The choice of surgical modality for laparoscopic hepatectomy for hepatocellular carcinoma (HCC) has not been supported by high level of medical evidence hitherto. A prospective randomised controlled trial (RCT) was conducted to compare the perioperative and follow-up outcomes of patients with HCC treated by laparoscopic anatomical hepatectomy (LAH) and non-anatomical hepatectomy (LNAH). Methods: Between March 2013 and Jan 2018, eligible patients undergoing LAH and LNAH were enrolled and divided randomly into LAH group and LNAH group in this study. The perioperative and follow-up outcomes of both groups were compared and analysed. Results: A total of 385 patients with HCC were randomly divided into LAH (n = 192) and LNAH (n = 193) groups. The groups were evenly matched for age, sex, liver background, segment involvement, tumor size, Child-Pugh grade and preoperative liver function. The operative time in the LAH group was longer than that of the LNAH group (p = 0.003). No significant between-group differences in intraoperative blood loss (p = 0.368), transfusion rate (p = 0.876), conversion to laparotomy rate (p = 0.365), overall complication rates (p = 0.054) were observed. The 1-year, 3-year and 5-year overall survival rates (OS) in the LAH group were 91.1%, 67.2%, 43.2%, respectively. The corresponding data in the LNAH group were 89.1%, 63.7%, and 35.2%, respectively. No significant difference was observed with regard to the 5-year OS rate (p = 0.054) between the two groups. The 1-year, 3-year and 5-year disease-free survival (DFS) rates in the LAH group were 87.0%, 54.7%, 33.9%, respectively. The corresponding data in LNAH group were 70.5%, 34.7%, and 30.1%, respectively. The 5-year DFS rate in the LAH group was significantly higher than that in the LNAH group (p = 0.009). Conclusions: LAH versus LNAH for selected HCC patients was associated with increased DFS, lower intrahepatic ipsilateral recurrence rate, comparable long-term OS and postoperative complications. LAH is therefore recommended for selected HCC patients. Registration number: NCT02009176 (https://www.clinicaltrials.gov/ ). Highlights: The choice of laparoscopic surgical modality for hepatocellular carcinoma (HCC) remains controversial. A prospective randomized controlled trial compared the perioperative and follow-up outcomes of patients with HCC treated by laparoscopic anatomic hepatectomy (LAH) and non-anatomic hepatectomy (LNAH). LAH is therefore recommended for selected HCC patients.