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Laparoscopic resection improved short-term outcomes in patients with cirrhotic liver cancer

Key clinical point: Patients with liver cancer and cirrhosis who underwent laparoscopic hepatic resections had lower postoperative morbidity and shorter hospital stays than patients who had open resections.

Major finding: Laparoscopy patients had significantly less postoperative morbidity (10% vs. 26%; P = .0459) and shorter hospital stays (10 vs. 16 days; P = .0008), compared with patients who underwent open resection, with no port site recurrences and no significant differences in long-term survival.

Data source:Retrospective, single-center study of 162 patients with cirrhosis and primary hepatocellular carcinoma who underwent curative hepatic resections, of whom 99 underwent open procedures and 63 underwent laparoscopies.

Disclosures: The authors disclosed no funding sources and reported having no conflicts of interest.


 

FROM THE JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS

References

Patients with liver cancer and cirrhosis who underwent laparoscopic hepatic resection had fewer complications, shorter hospital stays, no port site recurrences, and no significant difference in survival, compared with patients who had open resections, according to a single-center, 10-year study published online in the Journal of the American College of Surgeons.

The study is the first to report long-term favorable results of laparoscopic hepatic resection for liver cancer in patients with cirrhosis, said Dr. Yo-ichi Yamashita and associates at Kyushu University, Fukuoka, Japan. Based on the data, laparoscopic instead of open resection should be considered for patients with cirrhosis whose hepatocellular carcinomas fall within the Milan criteria, the investigators said (J. Am. Coll. Surg. 2014 Sept. 9 [doi: 10.1016/j.jamcollsurg.2014.09.003]).

Laparoscopy patients had healthier short-term outcomes than those who underwent open resection. ©avatavat/thinkstockphotos.com

Laparoscopy patients had healthier short-term outcomes than those who underwent open resection.

The retrospective study included 162 patients with cirrhosis and hepatocellular carcinoma within the Milan criteria. In all, 99 patients had open hepatic resections, while 63 underwent laparoscopic resections, the investigators said. Only 10% of laparoscopy patients had complications of grade 2 or higher, compared with 26% of open surgery cases (P = .0459), they reported. And while 7% of the open surgery patients developed ascites after surgery, none of the laparoscopy patients did (P = .0077), possibly because they experienced less tissue damage and because the deliberate induction of carbon dioxide pneumoperitoneum during laparoscopy can reduce local inflammatory responses, the researchers said. Laparoscopy patients also averaged 6 fewer days in the hospital after their procedures, Dr. Yamashita and associates reported (median length of stay, 10 vs. 16 days; P = .0008).

The laparoscopy group had no port site recurrences or peritoneal seeding of hepatocellular carcinoma, the investigators noted. Rates of disease-free and overall survival were similar between the two groups (P = .5196 and P = .6791, respectively), they added. Five-year and 10-year overall survival rates were 78% and 69% for laparoscopy patients, and were 77% and 57% for open resection patients, they said.

The authors disclosed no funding sources and reported having no conflicts of interest.

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