LAPAROSCOPIC VERSUS OPEN HEPATECTOMY FOR LARGE HEPATOCELLULAR CARCINOMA: A RANDOMIZED CONTROLLED STUDY

Background: Strong evidence from prospective studies for the superiority of either the open or laparoscopic approach in managing large HCC is still lacking. Aim was to compare surgical and oncologic efficiency of laparoscopic versus open hepatetcomy in solitary large (>5 cm) HCC in Child A cirrhotic patients. Methods: 150 patients with large HCC met the inclusion criteria and were randomly assigned to either OH group (75 patients) or LH group (75 patients). Results: LH had significantly less operative time (280.35 ± 24.69 versus 255.65 ± 22.63 minutes, P < .001), shorter duration of hospital stay (8.50 ± 0.78 versus 10.52 ± 0.78 days, P < .001), with comparable overall complications (43 versus 39%, P = .03). LH had comparative resection time (184.65 ± 47.50 versus 174.46 ± 29.35 minutes, P = .319), amount of blood loss (1060 versus 980mL, P = .817), transfusion rate (P = 1.00), and R0 resection rate when compared with OH. After median follow-up of 62.34 (34.52-89.47) months, LH achieved similar adequate oncological outcome of OH, no local recurrence, with no significant difference in early recurrence or number of de novo lesions (P = .42). One-year and 3-year disease free survival (DFS) rates, 69% and 39%, in the LH were comparable to corresponding rates of 65% and 36% in OH (P = .8). Conclusion: LH is superior to the OH in solitary large HCC with significantly shorter duration of hospital stay. LH does not compromise the oncological outcomes and achieve similar disease-free survival compared to OH.