Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma

Objective To summarize the clinical experience in laparoscopic hepatectomy in the treatment of hepatocellular carcinoma ( HCC) . Methods The patients with HCC who were admitted to Huaian No. 1 People's Hospital Affiliated to Nanjing Medical University, Drum Tower Hospital Affiliated to Nanjing University, and The Affiliated Hospital of Xuzhou Medical Hospital from December 2008 to December 2015 were enrolled and their clinical data were collected. According to the surgical procedure, these patients were divided into laparoscopic hepatectomy group with 391 patients ( LH group) and open hepatectomy group with 682 patients ( OR group) . The two groups were compared in terms of time of operation, incision size, intraoperative blood loss, postoperative recovery, length of postoperative hospital stay, surgery costs, hospital costs, and complications. The independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results There were significant differences between the LH group and the OR group in intraoperative blood loss ( 165. 00 ± 79. 21 ml vs 457. 00 ± 125. 00 ml, t = 41. 64, P < 0. 05) , length of incision ( 4. 07 ± 0. 31 cm vs 20. 48 ± 2. 36 cm, t = 136. 80, P < 0. 05) , time to diet ( 1. 50 ± 0. 61 d vs 2. 43 ± 0. 40 d, t =30. 10, P < 0. 05) , time to ambulation after surgery ( 1. 36 ± 0. 31 d vs 4. 12 + 0. 82 d, t = 63. 98, P < 0. 05) , length of hospital stay ( 10. 09 ± 3. 52 d vs 15. 36 ± 4. 57 d, t = 19. 70, P < 0. 05) , surgery costs ( 9471. 00 ± 639. 73 yuan vs 5329. 12 ± 461. 40 yuan, t =122. 44, P < 0. 05) , and hospital costs ( 37 315. 17 ± 13 194. 78 yuan vs 35 007. 6 ± 10 611. 20 yuan, t = 3. 13, P < 0. 05) . The 1-, 3-, and 5-year survival rates were 89. 42%, 64. 32%, and 43. 12% in the LH group and 88. 11%, 61. 45%, and 38. 38% in the OR group, and there were no significant differences between the two groups ( P > 0. 05) . Conclusion LH has the advantages of little trauma, low intraoperative blood loss, fast recovery, and short postoperative hospital stay and does not increase complications. Therefore, it can be used as the primary therapy for peripheral liver cancer, small hepatocellular carcinoma, and liver tumor in the left lateral lobe.