R I Troisi1,2, G Berardi1,2,3, Z Morise4, F Cipriani5, S Ariizumi6, C Sposito7, V Panetta8, I Simonelli8, S Kim9, B K P Goh10, S Kubo11, S Tanaka11, Y Takeda12, G M Ettorre13, N Russolillo14, G C Wilson15, M Cimino16, R Montalti17, M C Giglio1, K Igarashi3, C-Y Chan10, G Torzilli16, T T Cheung18, V Mazzaferro7, H Kaneko19, A Ferrero14, D A Geller15, H-S Han9, A Kanazawa20, G Wakabayashi3, L Aldrighetti5, M Yamamoto6. 1. Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy. 2. Department of Human Structure and Repair, Ghent University, Ghent, Belgium. 3. Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan. 4. Department of Surgery, Fujita Health University Hospital, Toyoake, Japan. 5. Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy. 6. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 7. Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy. 8. Biostatistics Department, Sapienza University of Rome, Rome, Italy. 9. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul,South Korea. 10. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore. 11. Department of Surgery, Osaka City University Hospital, Osaka, Japan. 12. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan. 13. Department of General and Hepato-Biliary-Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy. 14. Department of Surgery, Mauriziano Hospital, Turin, Italy. 15. Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 16. Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy. 17. Department of Public Health, Federico II University, Naples, Italy. 18. Division of Hepato-Biliary-Pancreatic and Liver Transplantation, Queen Mary Hospital, University of Hong Kong, Hong Kong, China. 19. Department of Surgery, Toho University of Tokyo, Tokyo, Japan. 20. Department of Surgery, Osaka City General Hospital, Osaka, Japan.
Abstract
BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS: Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS: Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION: Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
BACKGROUND: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS: Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS: Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION:Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
Authors: Tan-To Cheung; Xiaoying Wang; Mikhail Efanov; Rong Liu; David Fuks; Gi-Hong Choi; Nicholas L Syn; Charing C Chong; Iswanto Sucandy; Adrian K H Chiow; Marco V Marino; Mikel Gastaca; Jae Hoon Lee; T Peter Kingham; Mathieu D'Hondt; Sung Hoon Choi; Robert P Sutcliffe; Ho-Seong Han; Chung Ngai Tang; Johann Pratschke; Roberto I Troisi; Brian K P Goh Journal: Hepatobiliary Surg Nutr Date: 2021-10 Impact factor: 7.293
Authors: Maria Reig; Alejandro Forner; Jordi Rimola; Joana Ferrer-Fàbrega; Marta Burrel; Ángeles Garcia-Criado; Robin K Kelley; Peter R Galle; Vincenzo Mazzaferro; Riad Salem; Bruno Sangro; Amit G Singal; Arndt Vogel; Josep Fuster; Carmen Ayuso; Jordi Bruix Journal: J Hepatol Date: 2021-11-19 Impact factor: 30.083
Authors: D Koliogiannis; H Nieß; V Koliogiannis; M Ilmer; M Angele; J Werner; M Guba Journal: Langenbecks Arch Surg Date: 2022-06-08 Impact factor: 2.895