Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: A multi-institutional Japanese study

Takeshi Takahara, Go Wakabayashi, Toru Beppu, Arihiro Aihara, Kiyoshi Hasegawa, Naoto Gotohda, Etsuro Hatano, Yoshinao Tanahashi, Toru Mizuguchi, Toshiya Kamiyama, Tetsuo Ikeda, Shogo Tanaka, Nobuhiko Taniai, Hideo Baba, Minoru Tanabe, Norihiro Kokudo, Masaru Konishi, Shinji Uemoto, Atsushi Sugioka, Koichi HirataAkinobu Taketomi, Yoshihiko Maehara, Shoji Kubo, Eiji Uchida, Hiroaki Miyata, Masafumi Nakamura, Hironori Kaneko, Hiroki Yamaue, Masaru Miyazaki, Tadahiro Takada

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Abstract

Background The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. Methods Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. Results The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. Conclusion Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications. In this large propensity score matched study comparing laparoscopic and open liver resection for hepatocellular carcinoma, Takahara and colleagues confirmed that laparoscopic resection in selected patients is a recommended procedure associated with less blood loss, shorter hospital stay, and fewer postoperative complications than open resection, without compromising long-term outcomes. Table 3 Comparison of perioperative outcomes after propensity score matching (PSM) Matched-LLR (n = 387) Matched-OLR (n = 387) P Blood loss (ml) 158 (50, 450%) 400 (170, 675%) <0.001 RCC transfusion 28 (7.24%) 38 (9.82%) 0.198 FFP transfusion 17 (4.44%) 30 (7.85%) 0.049 Operation time (min) 294.4 ± 158.8 271.0 ± 130.0 0.025 Hospital stay (days) 13 (9, 18) 16 (11, 25) <0.001 Conversion Pure → Hybrid or HALS 7 (1.81%) - Pure → Open 7 (1.81%) - Hybrid or HALS → Open 11 (2.84%) - Accident Bleeding 9 (2.33%) 14 (3.79%) Injury of other organs 0 0 Others 1 (0.26%) 0 0.313 Complications 26 (6.72%) 50 (12.99%) 0.003 Ascites 7 12 Intraperitoneal abscess 4 4 Pleural effusion 2 5 Bile leak 5 9 Liver failure 2 7 Wound infection 1 4 Bleeding 1 1 Others 4 8 30 days mortality 0 1 (0.26%) 0.317 90 days mortality 1 (0.26%) 4 (1.03%) 0.178 FFP fresh frozen plasma, HALS hand-assisted laparoscopic surgery, RCC red cell concentration.

Original languageEnglish
Pages (from-to)721-727
Number of pages7
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume22
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

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Propensity Score
Hepatocellular Carcinoma
Liver
Length of Stay
Hand-Assisted Laparoscopy
Research Design
Hemorrhage
Mortality
Liver Failure
Wound Infection
Pleural Effusion

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching : A multi-institutional Japanese study. / Takahara, Takeshi; Wakabayashi, Go; Beppu, Toru; Aihara, Arihiro; Hasegawa, Kiyoshi; Gotohda, Naoto; Hatano, Etsuro; Tanahashi, Yoshinao; Mizuguchi, Toru; Kamiyama, Toshiya; Ikeda, Tetsuo; Tanaka, Shogo; Taniai, Nobuhiko; Baba, Hideo; Tanabe, Minoru; Kokudo, Norihiro; Konishi, Masaru; Uemoto, Shinji; Sugioka, Atsushi; Hirata, Koichi; Taketomi, Akinobu; Maehara, Yoshihiko; Kubo, Shoji; Uchida, Eiji; Miyata, Hiroaki; Nakamura, Masafumi; Kaneko, Hironori; Yamaue, Hiroki; Miyazaki, Masaru; Takada, Tadahiro.

In: Journal of Hepato-Biliary-Pancreatic Sciences, Vol. 22, No. 10, 01.10.2015, p. 721-727.

Research output: Contribution to journalArticle

Takahara, T, Wakabayashi, G, Beppu, T, Aihara, A, Hasegawa, K, Gotohda, N, Hatano, E, Tanahashi, Y, Mizuguchi, T, Kamiyama, T, Ikeda, T, Tanaka, S, Taniai, N, Baba, H, Tanabe, M, Kokudo, N, Konishi, M, Uemoto, S, Sugioka, A, Hirata, K, Taketomi, A, Maehara, Y, Kubo, S, Uchida, E, Miyata, H, Nakamura, M, Kaneko, H, Yamaue, H, Miyazaki, M & Takada, T 2015, 'Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: A multi-institutional Japanese study', Journal of Hepato-Biliary-Pancreatic Sciences, vol. 22, no. 10, pp. 721-727. https://doi.org/10.1002/jhbp.276
Takahara, Takeshi ; Wakabayashi, Go ; Beppu, Toru ; Aihara, Arihiro ; Hasegawa, Kiyoshi ; Gotohda, Naoto ; Hatano, Etsuro ; Tanahashi, Yoshinao ; Mizuguchi, Toru ; Kamiyama, Toshiya ; Ikeda, Tetsuo ; Tanaka, Shogo ; Taniai, Nobuhiko ; Baba, Hideo ; Tanabe, Minoru ; Kokudo, Norihiro ; Konishi, Masaru ; Uemoto, Shinji ; Sugioka, Atsushi ; Hirata, Koichi ; Taketomi, Akinobu ; Maehara, Yoshihiko ; Kubo, Shoji ; Uchida, Eiji ; Miyata, Hiroaki ; Nakamura, Masafumi ; Kaneko, Hironori ; Yamaue, Hiroki ; Miyazaki, Masaru ; Takada, Tadahiro. / Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching : A multi-institutional Japanese study. In: Journal of Hepato-Biliary-Pancreatic Sciences. 2015 ; Vol. 22, No. 10. pp. 721-727.
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title = "Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: A multi-institutional Japanese study",
abstract = "Background The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. Methods Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. Results The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7{\%} vs. 13.0{\%}, P = 0.003) was significantly less in LLR. Conclusion Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications. In this large propensity score matched study comparing laparoscopic and open liver resection for hepatocellular carcinoma, Takahara and colleagues confirmed that laparoscopic resection in selected patients is a recommended procedure associated with less blood loss, shorter hospital stay, and fewer postoperative complications than open resection, without compromising long-term outcomes. Table 3 Comparison of perioperative outcomes after propensity score matching (PSM) Matched-LLR (n = 387) Matched-OLR (n = 387) P Blood loss (ml) 158 (50, 450{\%}) 400 (170, 675{\%}) <0.001 RCC transfusion 28 (7.24{\%}) 38 (9.82{\%}) 0.198 FFP transfusion 17 (4.44{\%}) 30 (7.85{\%}) 0.049 Operation time (min) 294.4 ± 158.8 271.0 ± 130.0 0.025 Hospital stay (days) 13 (9, 18) 16 (11, 25) <0.001 Conversion Pure → Hybrid or HALS 7 (1.81{\%}) - Pure → Open 7 (1.81{\%}) - Hybrid or HALS → Open 11 (2.84{\%}) - Accident Bleeding 9 (2.33{\%}) 14 (3.79{\%}) Injury of other organs 0 0 Others 1 (0.26{\%}) 0 0.313 Complications 26 (6.72{\%}) 50 (12.99{\%}) 0.003 Ascites 7 12 Intraperitoneal abscess 4 4 Pleural effusion 2 5 Bile leak 5 9 Liver failure 2 7 Wound infection 1 4 Bleeding 1 1 Others 4 8 30 days mortality 0 1 (0.26{\%}) 0.317 90 days mortality 1 (0.26{\%}) 4 (1.03{\%}) 0.178 FFP fresh frozen plasma, HALS hand-assisted laparoscopic surgery, RCC red cell concentration.",
author = "Takeshi Takahara and Go Wakabayashi and Toru Beppu and Arihiro Aihara and Kiyoshi Hasegawa and Naoto Gotohda and Etsuro Hatano and Yoshinao Tanahashi and Toru Mizuguchi and Toshiya Kamiyama and Tetsuo Ikeda and Shogo Tanaka and Nobuhiko Taniai and Hideo Baba and Minoru Tanabe and Norihiro Kokudo and Masaru Konishi and Shinji Uemoto and Atsushi Sugioka and Koichi Hirata and Akinobu Taketomi and Yoshihiko Maehara and Shoji Kubo and Eiji Uchida and Hiroaki Miyata and Masafumi Nakamura and Hironori Kaneko and Hiroki Yamaue and Masaru Miyazaki and Tadahiro Takada",
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doi = "10.1002/jhbp.276",
language = "English",
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TY - JOUR

T1 - Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching

T2 - A multi-institutional Japanese study

AU - Takahara, Takeshi

AU - Wakabayashi, Go

AU - Beppu, Toru

AU - Aihara, Arihiro

AU - Hasegawa, Kiyoshi

AU - Gotohda, Naoto

AU - Hatano, Etsuro

AU - Tanahashi, Yoshinao

AU - Mizuguchi, Toru

AU - Kamiyama, Toshiya

AU - Ikeda, Tetsuo

AU - Tanaka, Shogo

AU - Taniai, Nobuhiko

AU - Baba, Hideo

AU - Tanabe, Minoru

AU - Kokudo, Norihiro

AU - Konishi, Masaru

AU - Uemoto, Shinji

AU - Sugioka, Atsushi

AU - Hirata, Koichi

AU - Taketomi, Akinobu

AU - Maehara, Yoshihiko

AU - Kubo, Shoji

AU - Uchida, Eiji

AU - Miyata, Hiroaki

AU - Nakamura, Masafumi

AU - Kaneko, Hironori

AU - Yamaue, Hiroki

AU - Miyazaki, Masaru

AU - Takada, Tadahiro

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. Methods Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. Results The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. Conclusion Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications. In this large propensity score matched study comparing laparoscopic and open liver resection for hepatocellular carcinoma, Takahara and colleagues confirmed that laparoscopic resection in selected patients is a recommended procedure associated with less blood loss, shorter hospital stay, and fewer postoperative complications than open resection, without compromising long-term outcomes. Table 3 Comparison of perioperative outcomes after propensity score matching (PSM) Matched-LLR (n = 387) Matched-OLR (n = 387) P Blood loss (ml) 158 (50, 450%) 400 (170, 675%) <0.001 RCC transfusion 28 (7.24%) 38 (9.82%) 0.198 FFP transfusion 17 (4.44%) 30 (7.85%) 0.049 Operation time (min) 294.4 ± 158.8 271.0 ± 130.0 0.025 Hospital stay (days) 13 (9, 18) 16 (11, 25) <0.001 Conversion Pure → Hybrid or HALS 7 (1.81%) - Pure → Open 7 (1.81%) - Hybrid or HALS → Open 11 (2.84%) - Accident Bleeding 9 (2.33%) 14 (3.79%) Injury of other organs 0 0 Others 1 (0.26%) 0 0.313 Complications 26 (6.72%) 50 (12.99%) 0.003 Ascites 7 12 Intraperitoneal abscess 4 4 Pleural effusion 2 5 Bile leak 5 9 Liver failure 2 7 Wound infection 1 4 Bleeding 1 1 Others 4 8 30 days mortality 0 1 (0.26%) 0.317 90 days mortality 1 (0.26%) 4 (1.03%) 0.178 FFP fresh frozen plasma, HALS hand-assisted laparoscopic surgery, RCC red cell concentration.

AB - Background The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. Methods Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. Results The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. Conclusion Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications. In this large propensity score matched study comparing laparoscopic and open liver resection for hepatocellular carcinoma, Takahara and colleagues confirmed that laparoscopic resection in selected patients is a recommended procedure associated with less blood loss, shorter hospital stay, and fewer postoperative complications than open resection, without compromising long-term outcomes. Table 3 Comparison of perioperative outcomes after propensity score matching (PSM) Matched-LLR (n = 387) Matched-OLR (n = 387) P Blood loss (ml) 158 (50, 450%) 400 (170, 675%) <0.001 RCC transfusion 28 (7.24%) 38 (9.82%) 0.198 FFP transfusion 17 (4.44%) 30 (7.85%) 0.049 Operation time (min) 294.4 ± 158.8 271.0 ± 130.0 0.025 Hospital stay (days) 13 (9, 18) 16 (11, 25) <0.001 Conversion Pure → Hybrid or HALS 7 (1.81%) - Pure → Open 7 (1.81%) - Hybrid or HALS → Open 11 (2.84%) - Accident Bleeding 9 (2.33%) 14 (3.79%) Injury of other organs 0 0 Others 1 (0.26%) 0 0.313 Complications 26 (6.72%) 50 (12.99%) 0.003 Ascites 7 12 Intraperitoneal abscess 4 4 Pleural effusion 2 5 Bile leak 5 9 Liver failure 2 7 Wound infection 1 4 Bleeding 1 1 Others 4 8 30 days mortality 0 1 (0.26%) 0.317 90 days mortality 1 (0.26%) 4 (1.03%) 0.178 FFP fresh frozen plasma, HALS hand-assisted laparoscopic surgery, RCC red cell concentration.

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