Laparoscopy versus Laparotomy for the Treatment of BCLC Stages 0 or A Hepatocellular Carcinoma Associated with or without Microvascular Invasion: A Multicenter, Propensity Score Matching Analysis

Purpose: To analyze the long-term prognoses of Barcelona Clinic Liver Cancer (BCLC) stages 0 or A hepatocellular carcinoma (HCC) patients associated with or without microvascular invasion (MVI) treated with laparoscopy versus laparotomy using propensity score matched analysis.Methods: The clinicopathological data of HCC patients at BCLC stages 0 or A from 4 major medical centers were retrospectively reviewed, and sub-grouped in terms of the presence of MVI to explore the effect of MVI on the long-term surgical outcomes. Propensity score matching (PSM) analysis was used to build a matched group of HCC patients for comparison of follow-up indicators between the laparoscopy and laparotomy groups.Results: 495 HCC patients at BCLC stages 0 or A were enrolled, including 243 in the laparoscopic group and 252 in the laparotomic group. Laparoscopic resection group had a shorter operative time, less blood loss, and lower frequencies of blood transfusion and postoperative complication rates. After PSM, the laparoscopic group had a significantly better overall survival (OS) and recurrence-free survival (RFS) than the laparotomic group. Subgroup analysis demonstrated OS and RFS of patients without MVI were also significantly improved in the laparoscopic group compared with the laparotomic group. However, no significant difference of OS and RFS between two groups was found in patients with MVI after PSM.Conclusions: Pure laparoscopic hepatectomy for HCC patients at early stages can be performed safely with favorable short-term and long-term outcomes at high-volume liver cancer centers, regardless of the presence of MVI.