Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis

Background: Few studies have compared survival and recurrence rates between laparoscopic and open liver resection for hepatocellular carcinoma in patients with cirrhosis. Methods: A retrospective analysis of a prospectively maintained database of 179 liver resections performed for HCC in cirrhotic liver between 2000 and 2007 was performed. Results: Fifty-four patients underwent a laparoscopic resection and 125 patients had open surgery. Histopathological features were largely comparable in the two groups. Tumours operated laparoscopically were smaller than those removed at open operation and laparoscopic liver resection was less extensive. Laparoscopic surgery had a lower morbidity rate than open surgery (19 versus 36.0 per cent; P = 0.020), whereas 30-day mortality was similar (2 versus 4.0 per cent; P = 0.615). After a median follow-up of 24 months, 1- and 3-year survival rates were 94 and 67 per cent in the laparoscopic group. Recurrence rates were similar after laparoscopic and open procedures (45 versus 52.5 per cent; P = 0.381), as was disease-free survival (P = 0.864). Conclusion: Laparoscopic resection of HCC in cirrhotic liver is feasible and safe in selected patients. Adequate long-term survival and recurrence is achieved compared with open surgery, when stratified for tumour characteristics known to be related to survival outcome.