Feasibility and Safety of Laparoscopic Liver Resection for Hepatocellular Carcinoma with a Tumor Size of 5–10 cmReportar como inadecuado




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Background

Although laparoscopic liver resection has developed rapidly and gained widespread acceptance for the treatment of benign liver diseases and hepatocellular carcinoma with a small tumor size, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the safety and feasibility of laparoscopic liver resection for the treatment of hepatocellular carcinoma with a tumor size of 5–10 cm.

Methods

From March 2007 to December 2011, we performed liver resection in 275 patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection was performed in 97 patients Lap-Hx group and open liver resection was performed in 178 patients Open-Hx group. Operative time, estimated intraoperative blood loss, blood transfusion rate, and length of postoperative hospital stay were compared between the two groups. Early and intermediate-term postoperative outcomes were also compared.

Results

Only one liver resection was performed for every patient with HCC in the present study.No operative deaths occurred in either group. Nine of the laparoscopic procedures were converted to open resection conversion rate 9.28%. There were no significant differences in mean operative time 245±105 min vs 225±112 min; P = .469, mean estimated intraoperative blood loss 460±426 mL vs 454±365 mL; P = .913, or blood transfusion rate 4.6%, 4-88 vs 2.8%, 5-178P = .480 between the Lap-Hx and Open-Hx groups. However, postoperative hospital stay was shorter in the Lap-Hx group than the Open-Hx group 8.2±3.6 days vs 13.5±3.8 days; P = .028. There was a lower rate of postoperative complications in the Lap-Hx group than the Open-Hx group 9% vs 30%; P = .001, but there were no severe complications in either group. The median overall follow-up time was 21 months range 2–50 months and the median follow-up of time of survivors was 23 months. The median follow-up time was 25 months in the Lap-Hx group and 20 months in the Open-Hx group. The follow-up rate was 95% 84 patients in the Lap-Hx group and 95% 169 patients in the Open-Hx group, which was not a significant difference between the two groups P = .20. Tumor recurrence occurred in 17 patients 20% in the Lap-Hx group and 35 patients 21% in the Open-Hx group, which was not a significant difference between the two groups P = .876. A total of 33 patients 13% died during the study period, including 12 patients 14% in the Lap-Hx group and 21 patients 12% in the Open-Hx group, which was not a significant difference between the two groups P = .695. There were also no significant differences in the 1-year rates of overall survival 94% vs 95%; P = .942 or disease-free survival 93% vs 92%; P = .941, or the 3-year rates of overall survival 86% vs 88%; P = .879 or disease-free survival 66% vs 67%; P = .931, between the Lap-Hx and Open-Hx groups.

Conclusions

Laparoscopic liver resection is safe and feasible in patients with hepatocellular carcinoma with a tumor size of 5–10 cm. Laparoscopic liver resection can avoid some of the disadvantages of open resection, and is beneficial in selected patients based on preoperative liver function, tumor size and location.



Autor: Jun-hua Ai , Jian-wei Li , Jian Chen, Ping Bie, Shu-guang Wang, Shu-Guo Zheng

Fuente: http://plos.srce.hr/



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