Laparoscopic Versus Open Hepatectomy For BCLC Stages 0–A Hepatocellular Carcinoma Patients:a Cohort Study

Part I: Laparoscopic versus Open Hepatectomy for BCLC Stages 0–A Hepatocellular Carcinoma Patients Associated with or without Microvascular Invasion: A Multicenter,Propensity Score Matching AnalysisPurpose: To analyze and compare the long-term oncological outcomes of Barcelona Clinic Liver Cancer(BCLC)stages 0–A hepatocellular carcinoma(HCC)patients associated with or without microvascular invasion(MVI)treated with laparoscopic versus open liver resection(OLR).Methods: Clinicopathological data of HCC patients with BCLC stages 0–A from 4medical centers were retrospectively reviewed.The survival outcomes of patients who underwent laparoscopic liver resection(LLR)were compared with those who underwent OLR.Subgroup analyses in terms of MVI were further performed to explore the effect of surgical approaches on the long-term survival outcomes.Propensity score matching(PSM)analysis was used to match patients between the laparoscopic and open hepatectomy groups in a 1:1 ratio.Results: 495 HCC patients at BCLC stages 0–A were enrolled,including 243 in the LLR group and 252 in the OLR group.The LLR group had a shorter operation time,less blood loss,a lower frequency of blood transfusion and postoperative complication rates.The LLR group had a significantly better overall survival(OS)and recurrence-free survival(RFS)than the OLR group before and after PSM.Subgroup analysis demonstrated that OS and RFS of patients without MVI were remarkably better in the LLR group compared with the OLR group.However,no significant differences in OS and RFS between the two groups were found in patients with MVI after PSM.Conclusions: Pure laparoscopic hepatectomy for patients with BCLC stages 0–A HCC can be performed safely with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers,regardless of the presence of MVI.Part II: Laparoscopic and open liver resection for hepatocellular carcinoma with type 2 diabetes mellitus: multicenter propensity scorematched studyPurpose: To analyze and compare the perioperative results and long-term oncological outcomes of hepatocellular carcinoma(HCC)patients with type 2 diabetes mellitus(T2DM)treated with laparoscopic versus open liver resection.Methods: Clinicopathological data of HCC patients with T2 DM who underwent laparoscopic liver resection(LLR)or open liver resection(OLR)as initial treatment from four medical centers were retrospectively reviewed.The survival outcomes of patients who underwent LLR were compared with those of patients who underwent OLR.Using the Kaplan-Meier method,survival curves for the two groups of patients were generated,and the log-rank test was used to compare survival differences.Propensity score matching(PSM)analysis was used to match patients of the LLR and OLR groups in a 1:1 ratio.Results: 230 HCC patients with T2 DM were enrolled,including 101 patients in the LLR group and 129 patients in the OLR group.After PSM,90 patients were matched in each of the study group.Compared with the OLR group,the LLR group had less blood loss,a shorter hospitalization and fewer postoperative complications.The LLR group had a significantly better overall survival(OS)and recurrence-free survival(RFS)than the OLR group before and after PSM.Subgroup analysis demonstrated that HCC patients with T2 DM had survival benefits from LLR regardless of the course of T2 DM.Conclusions: Laparoscopic liver resection for HCC patients with T2 DM can be safely performed with favorable perioperative and long-term oncological outcomes at high-volume liver cancer centers,regardless of the course of T2 DM.