Laparoscopic Hepatectomy versus Open Hepatectomy After Conversion Therapy Using Transarterial Chemoembolization or Hepatic Arterial Infusion Chemotherapy for Patients with Initially Unresectable Hepatocellular Carcinoma

Figures & data

Table 1 Baseline Characteristics of the 334 Patients Included in the Present Study

Variables	LH (n=63)	OH (n=271)	P value
Age (years)	56(29–75)	54(18–75)	0.882
Sex (male/female)	54/9	233/38	0.957
HBsAg positive (%)	60(95.2)	246(90.8)	0.25
Liver cirrhosis	41(65.1)	147(54.2)	0.247
Hypertension	6(9.5)	36(13.3)	0.417
Diabetes	8(12.7)	20(7.4)	0.17
Preoperative blood tests
AST (IU/L)	31.5(12.3–167.7)	36(14.9–223.7)	0.646
ALT (IU/L)	33.1(6.9–232.4)	25.4(4.5–107.2)	0.008
ALB (g/L)	41.3(35.1–45.7)	41.4(29.5–51.7)	0.965
TBIL (umol/L)	10.3(4.7–24.8)	10.7(3.8–42)	0.268
AFP (ng/mL)	31(1.8–12,310)	30.1(1.3–121,000)	0.042
PIVKA (mAU/mL)	108.7(6.3–30,846)	97(18–250,062)	0.49
WBC (10^9/L)	5.4(2.3–9.4)	5.4(1.9–20.1)	0.477
PLT (10^9/L)	193(74–331)	165(74–424)	0.632
PT (s)	11.7(10.4–13.9)	11.6(9.7–13.1)	0.965
Tumor burdens
Largest tumor size, cm (>5/≤5)	31/32	174/97	0.028
Tumor number (single/multiple)	31/32	165/106	0.426
Macrovascular invasion (yes/no)	6/57	69/202	0.006
Tumor-free margin (mm)	1(0–3)	0.5(0–6.5)	0.384
IMM grade (I/II/III)	16/12/35	56/29/186	0.093
ALBI score (I/II)	40/23	160/111	0.422
Conversion therapy (HAIC/TACE)	40/23	185/86	0.467
BCLC stage (A/B/C)	29/27/7	117/82/72	0.021
CNLC stage (Ia/Ib/IIa/IIb/IIIa/IIIb)	7/24/16/11/5/0	28/95/45/32/68/3	0.048

Notes: values are presented as the median (range) or n (%). All variables are evaluated before undergoing surgery.

Abbreviations: LH, laparoscopic hepatectomy; OH, open hepatectomy; AST, aspartate transaminase; ALT, alanine transaminase; ALB, albumin; TBIL, total bilirubin; AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence-II; WBC, white blood cell; PLT, platelet count; PT, prothrombin time; BCLC, Barcelona clinic liver cancer; CNLC, China liver cancer staging.

Table 2 Baseline Characteristics After Propensity Score Matching

Variables	LH (n=62)	OH (n=121)	P value
Age (years)	55(29–75)	56(18–75)	0.955
Sex (male/female)	53/9	104/17	0.932
HBsAg positive (%)	59(95.2)	111(91.7)	0.393
Liver cirrhosis	40(64.5)	71(64)	0.604
Hypertension	6(9.7)	16(13.2)	0.485
Diabetes	8(12.9)	8(6.6)	0.154
Preoperative blood tests
AST (IU/L)	30.4(12.3–167.7)	34.9(15.6–121.2)	0.734
ALT (IU/L)	33.1(6.9–232.4)	25.4(4.5–94.6)	0.055
ALB (g/L)	41.2(35.1–45.7)	41.2(29.5–48.4)	0.965
TBIL (umol/L)	10.3(4.7–24.8)	11(3.9–28.2)	0.262
AFP (ng/mL)	31(1.8–12,310)	19.7(1.3–121,000)	0.181
PIVKA (mAU/mL)	121(6.3–30,846)	65.6(19–250,062)	0.424
WBC (10^9/L)	5.4(2.3–9.4)	5.5(2.8–20.2)	0.555
PLT (10^9/L)	195(74–331)	177(74–424)	0.898
PT (s)	11.7(10.4–13.9)	11.8(10.2–13.8)	0.901
Tumor burdens
Largest tumor size, cm (>5/≤5)	31/31	58/63	0.791
Tumor number (single/multiple)	31/31	68/53	0.426
Macrovascular invasion (yes/no)	6/56	12/109	0.959
Tumor-free margin (mm)	1(0–3)	0.5(0–2.5)	0.10
IMM grade (I/II/III)	16/12/34	32/14/75	0.349
ALBI score (I/II)	39/23	70/51	0.434
BCLC stage (A/B/C)	29/26/7	59/48/14	0.957
CNLC stage (Ia/Ib/IIa/IIb/IIIa/IIIb)	7/23/16/11/5/0	20/41/28/18/13/1	0.845

Notes: values are presented as the median (range) or n (%). All variables are evaluated before undergoing surgery.

Abbreviations: LH, laparoscopic hepatectomy; OH, open hepatectomy; AST, aspartate transaminase; ALT, alanine transaminase; ALB, albumin; TBIL, total bilirubin; AFP, alpha-fetoprotein; PIVKA-II, protein induced by vitamin K absence-II; WBC, white blood cell; PLT, platelet count; PT, prothrombin time; BCLC, Barcelona clinic liver cancer; CNLC, China liver cancer staging.

Figure 1 Flow diagram.

Abbreviations: HCC, hepatocellular carcinoma; LH laparoscopic hepatectomy; OH, open hepatectomy.

Table 3 Operative Details of Patients Who Underwent LH and OH

Variables	LH (n=63)	OH (n=271)	P value
Blood loss (mL)	200(50–2000)	300(50–2500)	0.622
Plasma transfusion, n (%)	5(7.9)	27(10)	0.623
Erythrocyte transfusion, n (%)	4(6.3)	22(15.4)	0.637
Hospital stay (days)	9(5–15)	9(5–34)	0.653
Operative time (minutes)	154(90–315)	168(90–420)	0.057
Pringle maneuver, n (%)	43(68.3)	251(92.6)	<0.0001
Clamping times (minutes)	24(0–60)	22(0–75)	0.896
Postoperative complications, n (%)	19(30.2)	141(51.6)	0.007
Hepatic insufficiency	0	1
Biliary leakage	2	2
Pleural effusion	1	53
Peritoneal encapsulated effusion	10	50
Ascites	1	10
Pulmonary infection	1	2
Wound infection	0	9
Postoperative bleeding	4	14
Clavien-Dindo Classification, n (%)			0.469
I	57	225
II	6	42
III	0	3
IV	0	1

Note: values are presented as the median (range) or n (%).

Abbreviations: LH, laparoscopic hepatectomy; OH, open hepatectomy.

Table 4 Operative Details of Patients Who Underwent LH and OH After Propensity Score Matching

Variables	LH (n=62)	OH (n=121)	P value
Blood loss (mL)	200(50–2000)	300(100–1600)	0.978
Plasma transfusion, n (%)	5(7.9)	27(10)	0.623
Erythrocyte transfusion, n (%)	4(6.3)	22(15.4)	0.637
Hospital stay (days)	9(5–15)	8(5–30)	0.638
Operative times (minutes)	154(90–315)	168(90–420)	0.191
Pringle maneuver, n (%)	43(68.3)	114(94.2)	<0.0001
Clamping times (minutes)	23.5(0–60)	22(0–62)	0.764
Postoperative complications, n (%)	19(30.6)	60(49.6)	0.003
Hepatic insufficiency	0	0
Biliary leakage	2	2
Pleural effusion	1	26
Peritoneal encapsulated effusion	10	21
Ascites	1	2
Pulmonary infection	1	1
Wound infection	0	3
Postoperative bleeding	4	5
Clavien-Dindo Classification, n (%)			0.365
I	57	104
II	6	15
III	0	2
IV	0	0

Note: values are presented as the median (range) or n (%).

Abbreviations: LH, laparoscopic hepatectomy; OH, open hepatectomy.

Figure 2 (A) Overall and (B) recurrence-free survival, according to surgical approach (open versus laparoscopic) before PSM; (C) overall and (D) recurrence-free survival, according to surgical approach (open versus laparoscopic) after PSM.

Figure 3 Univariate and multivariate Cox regression analyses of risk factors for overall survival before PSM.

Data Sharing Statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.