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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2021

01-01-2021 | Liver Resection | Hepatobiliary Tumors

Major Laparoscopic Versus Open Resection for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis Based on Surgeons’ Learning Curve

Authors: Jonathan Geograpo Navarro, MD, Incheon Kang, MD, Seoung Yoon Rho, MD, Gi Hong Choi, MD, PhD, Dai Hoon Han, MD, PhD, Kyung Sik Kim, MD, PhD, Jin Sub Choi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2021

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Abstract

Background

Surgical complications for surgeons still in the learning phase of major laparoscopic liver resection (LLR) have been frequently observed. We aimed to compare perioperative and long-term outcomes of laparoscopic and open surgery based on the surgeons’ learning curve for LLR after propensity score-matched (PSM) analysis.

Methods

This was a retrospective study of all patients with a histologic diagnosis of hepatocellular carcinoma who underwent major hepatectomy between January 2013 and December 2018. A PSM analysis was used to compare the groups of patients who underwent LLR and open major liver resection (OLR) before and after the learning curve was maximized.

Results

Among 405 patients, 106 underwent LLR and 299 underwent OLR. The learning curve was maximized after 42 cases. Compared with OLR, LLR had more liver-related injury and grade III or higher complications during the learning phase. The LLR group had less blood loss, fewer transfusion requirements, and fewer liver-related complications during the ‘experienced’ phase. Hospital stay was significantly shorter during and after maximization of the learning curve in LLR compared with OLR. Operative time was comparable in the two phases. Overall, LLR was associated with less blood loss, fewer complications, and shorter hospital stay compared with open surgery. There was no significant difference in long-term survival outcomes between the two groups.

Conclusions

LLR had a higher incidence of liver-related complications during the surgeon’s learning phase compared with OLR. This association was significantly diminished with surgeon experience. Overall perioperative outcomes such as estimated blood loss, surgical complications, and hospital stay remained better for LLR compared with OLR.
Appendix
Available only for authorised users
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Metadata
Title
Major Laparoscopic Versus Open Resection for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis Based on Surgeons’ Learning Curve
Authors
Jonathan Geograpo Navarro, MD
Incheon Kang, MD
Seoung Yoon Rho, MD
Gi Hong Choi, MD, PhD
Dai Hoon Han, MD, PhD
Kyung Sik Kim, MD, PhD
Jin Sub Choi, MD, PhD
Publication date
01-01-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08764-4

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