Efficacy of laparoscopic liver resection for small hepatocellular carcinoma located in the posterosuperior segments: A multi-institutional study using propensity score matching by the Kyushu Study Group of Liver Surgery

Yukio Tokumitsu; Hiroaki Nagano; Yo-Ichi Yamashita; Tomoharu Yoshizumi; Toru Hisaka; Atsushi Nanashima; Tamotsu Kuroki; Takao Ide; Yuichi Endo; Tohru Utsunomiya; Kenji Kitahara; Yota Kawasaki; Masahiko Sakota; Kohji Okamoto; Yuko Takami; Masatoshi Kajiwara; Mitsuhisa Takatsuki; Toru Beppu; Susumu Eguchi

doi:10.1111/hepr.13929

Efficacy of laparoscopic liver resection for small hepatocellular carcinoma located in the posterosuperior segments: A multi-institutional study using propensity score matching by the Kyushu Study Group of Liver Surgery

Hepatol Res. 2023 Sep;53(9):878-889. doi: 10.1111/hepr.13929. Epub 2023 Jun 12.

Authors

Yukio Tokumitsu^{1

2}, Hiroaki Nagano^{1

2}, Yo-Ichi Yamashita^{1

3}, Tomoharu Yoshizumi^{1

4}, Toru Hisaka^{1

5}, Atsushi Nanashima^{1

6}, Tamotsu Kuroki^{1

7}, Takao Ide^{1

8}, Yuichi Endo^{1

9}, Tohru Utsunomiya^{1

10}, Kenji Kitahara^{1

11}, Yota Kawasaki^{1

12}, Masahiko Sakota^{1

13}, Kohji Okamoto^{1

14}, Yuko Takami^{1

15}, Masatoshi Kajiwara^{1

16}, Mitsuhisa Takatsuki^{1

17}, Toru Beppu^{1

18}, Susumu Eguchi^{1

19}

Affiliations

¹ Kyusyu Study Group of Liver Surgery, Fukuoka, Japan.
² Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
³ Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
⁴ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Kurume University, Kurume, Japan.
⁶ Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
⁷ Clinical Research Center and Department of Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
⁸ Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
⁹ Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine Graduate School of Medicine, Oita, Japan.
¹⁰ Department of Surgery, Oita Prefectural Hospital, Oita, Japan.
¹¹ Department of Surgery, Saga-Ken Medical Centre Koseikan, Saga, Japan.
¹² Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan.
¹³ Department of Surgery, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
¹⁴ Department of Surgery, Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
¹⁵ Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
¹⁶ Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
¹⁷ Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan.
¹⁸ Department of Surgery, Yamaga City Medical Center, Yamaga, Japan.
¹⁹ Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

PMID: 37255386
DOI: 10.1111/hepr.13929

Abstract

Aim: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in the posterosuperior segments (PS) have generally been considered more difficult than those for HCC in anterolateral segments (AL), but may be safe and feasible for selected patients with accumulated experience. In the present study, we investigated the effectiveness of LLR for single nodular HCCs ≤3 cm located in PS.

Methods: In total, 473 patients who underwent partial liver resection for single nodular HCCs ≤3 cm at the 18 institutions belonging to the Kyusyu Study Group of Liver Surgery from January 2010 to December 2018 were enrolled. The short-term outcomes of laparoscopic partial liver resection and open liver resection (OLR) for HCCs ≤3 cm, with subgroup analysis of PS and AL, were compared using propensity score-matching analysis. Furthermore, results were also compared between LLR-PS and LLR-AL.

Results: The original cohort of patients with HCC ≤3 cm included 328 patients with LLR and 145 with OLR. After matching, 140 patients with LLR and 140 with OLR were analyzed. Significant differences were found between groups in terms of volume of blood loss (median, 55 vs. 287 ml, p < 0.001), postoperative complications (0.71 vs. 8.57%, p = 0.003), and postoperative hospital stay (median, 9 vs. 14 days, p < 0.001). The results of subgroup analysis of PS were similar. Short-term outcomes did not differ significantly between LLR-PS and LLR-AL after matching.

Conclusions: Laparoscopic partial resection could be the preferred option for single nodular HCCs ≤3 cm located in PS.

Keywords: hepatocellular carcinoma; laparoscopic liver resection; multi-institutional study; posterosuperior segments; propensity score matching.