To investigate the learning curve and clinical efficacy of laparoscopic liver resection (LLR) for liver cancer.

Clinical data of 284 patients with liver cancer who underwent LLR in the First Affiliated Hospital of Xi'an Jiaotong University from January 2012 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 202 patients were male and 82 were female, aged from 30 to 79 years with a median age of 55 years. 256 patients were classified as Child-Pugh grade A and 28 cases grade B. The ICGR15 was 0.04-0.20. The learning period of LLR for our surgeons was from 2012 to 2017, and the stable period was from 2018 to 2019. The intraoperative and postoperative conditions and survival of patients were observed. The liver resection rate and the incidence of postoperative complications were compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

258 cases underwent LLR, including 26 cases converted to open surgery and 98 cases of extensive liver resection. The median operation time was 120(30-480) min, and the intraoperative blood loss was 400 (10-2 000) ml. 51 patients received blood transfusion with an intraoperative transfusion of 4(1-6) U red blood cells. The extensive liver resection rate in the stable period was 48.8%(80/164), significantly higher than 19.1%(18/94) during the learning period (χ2=22.3, P<0.05). The incidence of surgical complications in stable period was 3.0%(5/164), significantly lower than 9.6%(9/94) in learning period (χ2=4.6, P<0.05). The 1-, 3-year overall survival rates were 95.8% and 88.2%, and the 1-, 3-year disease-free survival rates were 77.1% and 49.0%, respectively.

LLR is a safe and feasible treatment for liver cancer, which yields satisfactory long-term clinical efficacy. During the learning period, proper cases should be selected. Extensive attention should be paid to the prevention and treatment for postoperative complications.