Laparoscopic hepatectomy is feasible for patients diagnosed with hepatocellular carcinoma and cirrhotic liver

Table 1 Liver damage grade according to the Liver Cancer Study Group of Japan

	A	B	C
Ascites	Absent	Curative	Minimal therapeutic effect
Serum bilirubin (mg/dL)	< 2.0	2.0-3.0	> 3.0
Serum albumin (g/dL)	> 3.5	3.0-3.5	< 3.0
ICG R15 (%)	< 15	15-40	> 40
Prothrombin activity (%)	> 80	50-80	< 50

ICG R15: Indocyanine green retention at 15 min.

Table 2 Patient characteristics

	Before propensity score matching			After propensity score matching
	Open group, n = 71	Laparoscopic group, n = 26	P value	Open group, n = 19	Laparoscopic group, n = 19	P value
Age (years)	67.7 ± 13.8	71.3 ± 6.8	0.21	69.4 ± 7.0	70.7 ± 6.3	0.56
Male	54 (76.1)	13 (50)	0.014	13 (68.4)	11 (57.9)	0.5
BMI (kg/m2)	24.0 ± 4.2	25.2 ± 3.1	0.19	24.8 ± 4.2	25.0 ± 3.2	0.89
Etiology
HBsAg-positive	5 (7.1)	1 (3.9)	0.56	1 (5.3)	1 (5.3)	1
Anti-HCV-positive	29 (40.9)	13 (50.0)	0.42	7 (36.8)	8 (42.1)	0.74
Preoperative assessment
Total bilirubin (mg/dL)	1.1 ± 0.6	1.1 ± 0.4	0.54	1.2 ± 0.5	1.1 ± 0.5	0.59
Albumin (g/dL)	3.6 ± 0.5	3.6 ± 0.3	0.91	3.6 ± 0.1	3.6 ± 0.1	0.91
ICG R15 (%)	26.8 ± 10.3	32.5 ± 11.7	0.02	31.3 ± 11.7	30.1 ± 12.0	0.75
PT (%)	73.7 ± 11.4	70.4 ± 9.9	0.19	69.0 ± 9.7	70.6 ± 10.8	0.63
Platelet count (× 104/µL)	14.0 ± 8.9	9.7 ± 3.8	0.027	11.7 ± 9.6	10.0 ± 4.2	0.51
Ascites-present	8 (11.3)	1 (3.9)	0.26	2 (13.3)	0 (0)	0.11
Child-Pugh class A	62 (87.3)	24 (92.3)	0.49	16 (84.2)	18 (94.7)	0.29
Child-Pugh class B	9 (12.7)	2 (7.7)		3 (15.8)	1 (5.3)
Tumor characteristics
α-fetoprotein (ng/mL)	4099 ± 16987	85 ± 346	0.25	646 ± 2483	116 ± 411	0.39
PIVKA-2 (mAU/mL)	11877 ± 72439	671 ± 2326	0.45	1326 ± 4100	909 ± 2750	0.73
Tumor size (cm)	4.5 ± 3.1	2.7 ± 1.2	0.004	2.9 ± 1.3	2.9 ± 1.3	1
Tumor number-multiple	24 (33.8)	5 (19.2)	0.17	5 (26.3)	4 (21.1)	0.7
Tumor location
Anterolateral segment	33 (46.5)	21 (80.8)	0.003	9 (47.4)	14 (73.7)	0.1
Posterosuperior segment	38 (53.5)	5 (19.2)		10 (52.6)	5 (26.3)

Data are shown as n (%) or mean ± SD. HBsAg: Hepatitis B virus surface protein; HCV: Hepatitis C virus; PT: Prothrombin activity level; ICG R15: Indocyanine green retention at 15 minutes; BMI: Body mass index; PIVKA-2: Protein induced by vitamin K absence of antagonist-2.

Table 3 Operative procedures and results

	Before propensity score matching			After propensity score matching
	Open group, n = 71	Laparoscopic group, n = 26	P value	Open group, n = 19	Laparoscopic group, n = 19	P value
BAN score
Low	14 (19.7)	15 (57.7)	< 0.001	10 (52.6)	8 (42.1)	0.780
Intermediate	20 (28.2)	8 (30.8)		7 (36.8)	8 (42.1)
High	37 (52.1)	3 (11.5)		2 (10.5)	3 (15.8)
Surgical procedure
Hemihepatectomy	2 (2.8)	0 (0)	0.003	0 (0)	0 (0)	1.000
Sectionectomy	15 (21.1)	1 (3.9)		1 (5.3)	1 (5.3)
Segmentectomy	21 (29.6)	3 (11.5)		3 (15.8)	3 (15.8)
Partial hepatectomy	33 (46.5)	22 (84.6)		15 (79.0)	15 (79.0)
Operative time (minute)	250 ± 114	214 ± 90	0.140	225 ± 114	216 ± 89	0.770
Blood loss (18)	1169 ± 1994	199 ± 374	0.016	941 ± 1436	242 ± 427	0.049
Pathological findings
High differentiation	8 (11.3)	5 (19.2)	0.220	2 (10.5)	3 (15.8)	0.690
Moderately differentiation	37 (52.1)	16 (61.6)		12 (63.2)	13 (68.4)
Poorly differentiation	26 (36.6)	5 (19.2)		5 (26.3)	3 (15.8)
Microscopic portal vein invasion	22 (31.0)	3 (11.5)	0.050	3 (15.8)	2 (10.5)	0.630
Intrahepatic metastasis	17 (23.9)	4 (15.4)	0.360	3 (15.8)	3 (15.8)	1.000
Surgical margin-positive	7 (9.9)	1 (3.9)	0.340	1 (5.3)	0 (0)	0.310
Cirrhosis	47 (66.2)	24 (92.3)	0.010	16 (84.2)	17 (89.5)	0.630

Data are shown as n (%) or mean ± SD. BAN score: Ban Difficulty Scoring System.

Table 4 Short-term and long-term results

	Before propensity score matching			After propensity score matching
	Open group, n = 71	Laparoscopic group, n = 26	P value	Open group, n = 19	Laparoscopic group, n = 19	P value
Short-term outcome
Length of stay (day)	27 ± 17	17 ± 14	0.010	24 ± 10	19 ± 16	0.260
Ascites (C-D I or II)	13 (18.3)	0 (0)	0.019	4 (21.1)	0 (0)	0.035
Ascites (C-D III or IV)	3 (4.2)	0 (0)	0.290	0 (0)	0 (0)	NA
Bile leakage (C-D III or IV)	6 (8.5)	1 (3.9)	0.440	1 (5.3)	1 (5.3)	1.000
Liver failure (C-D III or IV)	9 (12.7)	3 (11.5)	0.880	2 (10.5)	2 (10.5)	1.000
All morbidity (C-D III or IV)	14 (19.7)	3 (11.5)	0.350	3 (15.8)	2 (10.5)	0.630
Mortality at 30 days	0 (0)	0 (0)	NA	0 (0)	0 (0)	NA
Mortality at 90 days	3 (4.2)	0 (0)	0.290	0 (0)	0 (0)	NA
Long-term outcome
Recurrence	47 (66.2)	14 (53.9)	0.260	11 (57.9)	9 (47.4)	0.520
Death	38 (53.5)	4 (15.4)	0.001	10 (52.6)	2 (10.5)	0.005
Cancer	27 (38.0)	4 (15.4)	0.018	7 (36.8)	2 (10.5)	0.080
Liver failure due to cirrhosis	5 (7.0)	0 (0)	0.160	1 (5.3)	0 (0)	0.310
Infection	4 (5.6)	0 (0)	0.220	1 (5.3)	0 (0)	0.310
Other cancer	2 (2.8)	0 (0)	0.390	1 (5.3)	0 (0)	0.310

Data are shown as n (%) or mean ± SD. NA: Not available.