To evaluate the safety and efficacy of laparoscopic hepatectomy combined with Hassab's procedure in the treatment of primary liver cancer (PLC) complicated with portal hypertension based on propensity score matching (PSM).

Clinical data of 82 PLC patients complicated with portal hypertension who underwent hepatectomy combined with Hassab's procedure in Beijing Ditan Hospital affiliated to Capital Medical University from January, 2013 to December, 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 62 patients were male and 20 female, aged from 22 to 70 years, with a median age of52 years. According to different surgical methods, all patients were divided into the laparoscopic surgery group (n=36) and open surgery group (n=46). Baseline data in two groups were subject to 1∶1 PSM, and 25 patients were enrolled in each group. Perioperative conditions and clinical prognosis were observed between two groups. The length of postoperative hospital stay was compared by Mann-Whitney U test. The incidence of postoperative complications was compared with Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

In the laparoscopic surgery group, the median off-bed activity time, postoperative feeding time and the length of postoperative hospital stay were 3(3), 4(3) and 11(6) d, significantly shorter than 5(1), 5(1) and 16(9) d in the open surgery group (Z=-4.162, -3.682, -3.785; P<0.05). The incidence of postoperative complications in the laparoscopic surgery group was 48%(12/25), significantly lower than 76%(19/25) in the open surgery group (χ²=4.160, P<0.05). In the laparoscopic surgery group, postoperative complications were mainly classified as gradeⅠ, whereas gradeⅡand Ⅲ in the open surgery group (P=0.007). In the laparoscopic surgery group, the incidence of ascites was 24%(6/25), significantly lower than 52%(13/25) in the open surgery group (χ²=4.160, P<0.05). In the laparoscopic surgery group, the postoperative 1-, 3- and 5-year tumor-free survival rates were 88.0%, 64.4% and 59.0%, and 88.0%, 75.3% and 57.0% in the open surgery group, respectively. In the laparoscopic surgery group, the postoperative 1-, 3- and 5-year overall survival rates were 95.7%, 86.3% and 79.1%, and 100%, 89.8% and 80.9% in the open surgery group, respectively. No significant differences were noted in the postoperative tumor-free and overall survival rates between two groups (χ²=0.080, 0.044; P>0.05).

Laparoscopic hepatectomy combined with Hassab's procedure is a safe and efficacious treatment for PLC patients complicated with portal hypertension based upon comprehensive liver function evaluation. Compared with open surgery, laparoscopic hepatectomy combined with Hassab's procedure possesses multiple advantages of minimal invasiveness, rapid postoperative recovery and low incidence of postoperative complications.