Víctor Lopez-Lopez1, Roberto Brusadin1, Asunción López-Conesa1, Antonio Capel2, Álvaro Navarro-Barrios1, Valentín Cayuela1, Elena Lopez-Banet3, Alejandro Garzón-Arana4, Pascual Parrilla-Paricio1, Ricardo Robles-Campos5. 1. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain. 2. Department of Interventional Radiology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain. 3. Department of Radiology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain. 4. Department of Surgical Pathology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain. 5. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain. rirocam@um.es.
Abstract
PURPOSE: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) offers better short-term results than open surgery with similar long-term results although it is technically difficult due to the risk of bleeding. METHODS: This study included patients with HCC in Child A cirrhosis who underwent TACE before LLR between 2009 and 2019. The primary endpoint was to analyze the intraoperative and early results of this technique. We also analyzed the long-term outcomes. Patients with and without clinically significant portal hypertension (CSPH) were compared. RESULTS: A total of 44 cirrhotic patients with HCC were included (24 CSPH and 20 non-CSPH). The Pringle maneuver was used in two cases (4.5%), mean blood losses was 100 ml (range 50-200), and three patients (6.8%) required a blood transfusion. The degree of necrosis achieved was greater than 90% in 27 patients (61.4%). At 1, 3, and 5 years, overall survival was 97.7%, 81.5%, and 63.4%, respectively, and disease-free survival was 85.2%, 52.5%, and 34.5%, respectively. There were no statistically significant differences between non-CSPH and CSPH groups regarding intraoperative, early, and long-term outcomes. CONCLUSION: In our experience, TACE could be beneficial to perform LLR in HCC Child-Pugh A patients with and without CSPH without serious complications and similar oncological outcomes.
PURPOSE: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) offers better short-term results than open surgery with similar long-term results although it is technically difficult due to the risk of bleeding. METHODS: This study included patients with HCC in Child A cirrhosis who underwent TACE before LLR between 2009 and 2019. The primary endpoint was to analyze the intraoperative and early results of this technique. We also analyzed the long-term outcomes. Patients with and without clinically significant portal hypertension (CSPH) were compared. RESULTS: A total of 44 cirrhotic patients with HCC were included (24 CSPH and 20 non-CSPH). The Pringle maneuver was used in two cases (4.5%), mean blood losses was 100 ml (range 50-200), and three patients (6.8%) required a blood transfusion. The degree of necrosis achieved was greater than 90% in 27 patients (61.4%). At 1, 3, and 5 years, overall survival was 97.7%, 81.5%, and 63.4%, respectively, and disease-free survival was 85.2%, 52.5%, and 34.5%, respectively. There were no statistically significant differences between non-CSPH and CSPH groups regarding intraoperative, early, and long-term outcomes. CONCLUSION: In our experience, TACE could be beneficial to perform LLR in HCC Child-Pugh A patients with and without CSPH without serious complications and similar oncological outcomes.
Authors: Giovanni Battista Levi Sandri; Giuseppe Maria Ettorre; Luca Aldrighetti; Umberto Cillo; Raffaele Dalla Valle; Alfredo Guglielmi; Vincenzo Mazzaferro; Alessandro Ferrero; Fabrizio Di Benedetto; Salvatore Gruttadauria; Luciano De Carlis; Giovanni Vennarecci Journal: Surg Endosc Date: 2018-09-10 Impact factor: 4.584