Federica Cipriani1,2, Corrado Fantini3, Francesca Ratti2, Roberto Lauro4, Hadrien Tranchart5, Mark Halls1, Vincenzo Scuderi6, Leonid Barkhatov7, Bjorn Edwin7,8, Roberto I Troisi6, Ibrahim Dagher5, Paolo Reggiani4, Giulio Belli3, Luca Aldrighetti2, Mohammad Abu Hilal9. 1. University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK. 2. Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy. 3. General and Hepato-Pancreato-Biliary Surgery, Loreto Nuovo Hospital, Naples, Italy. 4. Hepatobiliary and Liver Transplant Unit, IRCCS Foundation Policlinico Major Hospital, Milan, Italy. 5. Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Clamart, France. 6. Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium. 7. Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 9. University Hospital Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK. abuhilal9@gmail.com.
Abstract
BACKGROUND: Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients. METHODS: The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child-Pugh A and 25 Child-Pugh B patients. RESULTS: There was no difference in blood loss (250 vs. 250 mL, p 0.465) and morbidity (28.6 vs. 26.4%, p 0.473) between cirrhotics and non-cirrhotics, and liver-specific complications were similar (12.8 vs. 12%, p 0.924). The sub-analysis revealed similar perioperative outcomes in either Child-Pugh A or B patients. Noteworthy, ascitis (11 vs. 12%, p 0.562) and liver failure (3 vs. 4%, p 0.595) were not different. ASA score (OR 1.76, p 0.034) and conversion (OR 2.99, p 0.019) were risk factors for major morbidity. Despite lower recurrence-free survival in cirrhotics (43 vs. 55 months, p 0.034), overall survival was similar to non-cirrhotic patients (84 vs. 76.5, p 0.598). CONCLUSION: LLR for HCC appear equally safe in cirrhotic and non-cirrhotic patients, and the advantages can be witnessed in those with advanced cirrhosis. Severe comorbidities and conversion should be considered risk factors for complications-rather than the severity of cirrhosis and portal hypertension-when liver resection is performed laparoscopically. Such results may be of great interest to liver surgeons and hepatologists when deciding on the management of HCC within cirrhosis.
BACKGROUND: Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCCpatients. METHODS: The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child-Pugh A and 25 Child-Pugh B patients. RESULTS: There was no difference in blood loss (250 vs. 250 mL, p 0.465) and morbidity (28.6 vs. 26.4%, p 0.473) between cirrhotics and non-cirrhotics, and liver-specific complications were similar (12.8 vs. 12%, p 0.924). The sub-analysis revealed similar perioperative outcomes in either Child-Pugh A or B patients. Noteworthy, ascitis (11 vs. 12%, p 0.562) and liver failure (3 vs. 4%, p 0.595) were not different. ASA score (OR 1.76, p 0.034) and conversion (OR 2.99, p 0.019) were risk factors for major morbidity. Despite lower recurrence-free survival in cirrhotics (43 vs. 55 months, p 0.034), overall survival was similar to non-cirrhotic patients (84 vs. 76.5, p 0.598). CONCLUSION: LLR for HCC appear equally safe in cirrhotic and non-cirrhotic patients, and the advantages can be witnessed in those with advanced cirrhosis. Severe comorbidities and conversion should be considered risk factors for complications-rather than the severity of cirrhosis and portal hypertension-when liver resection is performed laparoscopically. Such results may be of great interest to liver surgeons and hepatologists when deciding on the management of HCC within cirrhosis.
Entities:
Keywords:
Child–Pugh; Cirrhosis; Hepatocellular carcinoma; Laparoscopic liver resection; Portal hypertension; Risk factors for major morbidity
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