Laparoscopic liver resection should be a standard procedure for hepatocellular carcinoma with low or intermediate difficulty

Ruoh Yun Gau, Ming Chin Yu, Hsin I. Tsai, Cheng Han Lee, Tony Kuo, Kuan Chieh Lee, Wei Chen Lee, Kun Ming Chan, Chien Chih Chiu, Chao Wei Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

5 Scopus citations


Background: To investigate the feasibility of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC), we compared the outcome between LLR and conventional open liver resection (OLR) in patient groups with different IWATE criteria difficulty scores (DS). Methods: We retrospectively reviewed 607 primary HCC patients (LLR: 81, OLR: 526) who underwent liver resection in Linkou Chang Gung Memorial hospital from 2012 to 2019. By using 1:1 propensity score-matched (PSM) analysis, their baseline characteristics and the DS stratified by the IWATE criteria were matched between the LLR and OLR. Their perioperative and oncologic outcomes were compared. Results: After 1:1 PSM, 146 patients (73 in LLR, 73 in OLR) were analyzed. Among them, 13, 41, 13 and 6 patients were classified as low, intermediate, advanced and expert DS group, respectively. Compared to OLR, the LLR had shorter hospital stay (9.4 vs. 11.5 days, p = 0.071), less occurrence of surgical complications (16.4% vs. 30.1%, p = 0.049), lower rate of hepatic inflow control (42.5% vs. 65.8%, p = 0.005), and longer time of inflow control (70 vs. 51 min, p = 0.022). The disease-free survival (DFS) and overall survivals were comparable between the two groups. While stratified by the DS groups, the LLR tended to have lower complication rate and shorter hospital stay than OLR. The DFS of LLR in the intermediate DS group was superior to that of the OLR (p = 0.020). In the advanced and expert DS groups, there were no significant differences regarding outcomes between the two groups. Conclusion: We have demonstrated that with sufficient experience and technique, LLR for HCC is feasible and the perioperative outcome is favorable. Based on the current study, we suggest LLR should be a standard procedure for HCC with low or intermediate difficulty. It can provide satisfactory postoperative recovery and comparable oncological outcomes. Further larger scale prospective studies are warranted to validate our findings.

Original languageEnglish
Article number266
JournalJournal of Personalized Medicine
Issue number4
StatePublished - 2021

Bibliographical note

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.


  • Difficulty score
  • Hepatectomy
  • Hepatocellular carcinoma
  • Hepatoma
  • IWATE criteria
  • Laparoscopic
  • Liver resection


Dive into the research topics of 'Laparoscopic liver resection should be a standard procedure for hepatocellular carcinoma with low or intermediate difficulty'. Together they form a unique fingerprint.

Cite this