Zero Hospital Mortality and Improved Long Tern Survival in Laparoscopic Hepatectomy for Patients with HCC - A Propensity Score Analysis of 836 Patients

Objective: To investigate the long-term outcomes of pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma (HCC). Methods: Propensity score matching of patients receiving laparoscopic and open approach in a ratio of 1:3 was conducted. Blood for cytokine and chemokines expression was collect prospectively for comparison before and after surgery. Results: There were 209 patients and 627 patients in the laparoscopic group and the open group, respectively. The laparoscopic group had less blood loss (200 vs 500 mL; P < 0.001), shorter operation time (201 vs 277 minutes; P < 0.001), and shorter hospital stay (4 vs 7 days; P < 0.001). There was zero hospital mortality in laparoscopic group. The 1, 3, and 5-year overall survival rates were 98.3%, 90.5%, and 82.4%, respectively, in the laparoscopic group, and 93.5%, 78.7%, and 67.9%, respectively, in the open group (P=0.006). The median disease-free survival was 73.1 months in the laparoscopic group and 42.7 months in the open group. The 1, 3, and 5-year disease-free survival rates were 84.1%, 66.0%, and 54.6%, respectively, in the laparoscopic group, and 73.1%, 52.1%, 44.2%, respectively, in the open group (P=0.003). The median IL6 and IL8 were comparable before surgery. The median IL6 and IL8 were significantly lower in patients receiving laparoscopic hepatectomy. Conclusions: An improved survival benefit is observed for laparoscopic hepatectomy for HCC with lower perioperative IL6 and IL8 expression.