Laparoscopic versus open hepatectomy for liver tumours: a case control study

KF Lee, YS Cheung, CN Chong, Yvonne YY Tsang, Wilson WC Ng, Eva Ling, John Wong, Paul BS Lai
Division of Hepato-biliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

OBJECTIVE. To evaluate the benefits of laparoscopic versus open resection of liver tumours.

DESIGN. Case control study.

SETTING. Tertiary teaching hospital, Hong Kong.

PATIENTS. Data from 25 patients who underwent laparoscopic resections for liver tumours from 2003 to 2006 were compared to a retrospective series of 25 patients who underwent open hepatectomy in a pair-matched design.

MAIN OUTCOME MEASURES. Duration of operation, operative morbidity and mortality, blood loss, tumour resection margin, analgesics usage, days to return to an oral diet, duration of postoperative hospital stay, and survival of patients with malignancy.

RESULTS. The demographic data and the tumour characteristics were comparable in the two patient groups, as were mortality (0% in both groups) and morbidity rates (4% in both groups). Two (8%) of the patients having laparoscopic resections were converted to open surgery. There was no statistically significant difference between the two groups in terms of operating time or resection margins. However, the laparoscopically treated patients experienced significantly less blood loss (median, 100 vs 250 mL), had shorter hospital stays (median, 4 vs 7 days), were prescribed less analgesia (median morphine dosage, 0.16 vs 0.83 mg per kg body weight), and resumed oral diet earlier (median, 1 vs 2 days). For patients with malignant tumours, there was no significant difference between the two groups in terms of actuarial and disease-free survival.

CONCLUSION. Compared to open hepatectomy, in selected patients laparoscopic liver resection delivers the benefits of decreased blood loss, shorter hospital stay, lesser requirement for analgesics, and an earlier return to an oral diet, without evidence of compromised oncological clearance.

Hong Kong Med J 2007;13:442-8

Key words: Hepatectomy; Laparoscopy; Liver diseases; Liver neoplasms; Treatment outcome