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

BACKGROUND

Hepatocellular carcinoma (HCC) commonly arises in cirrhotic livers. Laparoscopic hepatectomy (LH) has shown promising outcomes, but its safety in moderate liver dysfunction remains unclear. Despite comparable surgical indications for LH and open hepatectomy (OH), data on impaired liver function are scarce. The Japanese Liver Damage Grading System (LDGS), incorporating indocyanine green retention at 15 min, provides a precise functional assessment.

AIM: To compare short-term and long-term outcomes of LH and OH in patients with HCC LDGS grade B or C.

METHODS

The 97 patients with HCC and LDGS grade B or C who underwent hepatectomy (26 LH; 71 OH) between 2010 and 2022 at Tokyo Women's Medical University Hospital were retrospectively analyzed. Propensity score matching (1:1) was applied. Baseline biochemical and tumor characteristics were compared. Short-term and long-term outcomes were assessed.

RESULTS

Before matching patients who underwent LH had smaller tumors (2.7 cm vs 4.5 cm, P = 0.004) and lower surgical difficulty scores (P < 0.001). After matching LH was associated with lower intraoperative blood loss (242 mL vs 941 mL; P = 0.049), reduced postoperative ascites (0% vs 21.2%; P = 0.035), and shorter hospital stay with no conversion to OH. The 5-year overall survival rate was significantly higher in the LH group (91% vs 36%; P = 0.021) while recurrence-free survival was comparable.

CONCLUSION

LDGS provides a comprehensive assessment of surgical candidates with moderate cirrhosis. In patients with HCC and grade B or C liver damage, LH appears to have better long-term outcomes than OH due to reduced morbidity and preservation of liver function.