Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis.
Aged
Carcinoma, Hepatocellular
/ complications
Female
Hepatectomy
/ methods
Humans
Hypertension, Portal
/ complications
Liver Neoplasms
/ complications
Male
Middle Aged
Minimally Invasive Surgical Procedures
Platelet Count
Portal Pressure
Portal Vein
/ surgery
Retrospective Studies
Thrombocytopenia
/ complications
Treatment Outcome
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
29
12
2019
pubmed:
11
4
2020
medline:
7
4
2021
entrez:
11
4
2020
Statut:
ppublish
Résumé
Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared. Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized. Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08]. An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared.
METHODS
METHODS
Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized.
RESULTS
RESULTS
Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08].
CONCLUSION
CONCLUSIONS
An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.
Identifiants
pubmed: 32274662
doi: 10.1245/s10434-020-08444-3
pii: 10.1245/s10434-020-08444-3
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3360-3371Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
pubmed: 30207593
Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68(2):723–50.
European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.
Kinoshita A, Onoda H, Fushiya N, Koike K, Nishino H, Tajiri H. Staging systems for hepatocellular carcinoma: current status and future perspectives. World J Hepatol. 2015;7(3):406–24.
pubmed: 25848467
pmcid: 4381166
Bagante F, Spolverato G, Strasberg SM, Gani F, Thompson V, Hall BL, et al. Minimally invasive vs. open hepatectomy: a comparative analysis of the national surgical quality improvement program database. J Gastrointest Surg. 2016;20(9):1608–17.
Chen Q, Merath K, Bagante F, Akgul O, Dillhoff M, Cloyd J, et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections among the medicare population. J Gastrointest Surg. 2018;22(12):2088–96.
pubmed: 30039449
Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, et al. The southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 2018;268(1):11–8.
pubmed: 29064908
Witowski J, Rubinkiewicz M, Mizera M, Wysocki M, Gajewska N, Sitkowski M, et al. Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients. Surg Endosc. 2019;33(5):1491–1507.
pubmed: 30203210
Xiong JJ, Altaf K, Javed MA, Huang W, Mukherjee R, Mai G, et al. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. World J Gastroenterol. 2012;18(45):6657–68.
pubmed: 23236242
pmcid: 3516221
Yoon YI, Kim KH, Kang SH, Kim WJ, Shin MH, Lee SK, et al. Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann Surg. 2017;265(5):856–63.
pubmed: 27849661
Shehta A, Han HS, Yoon YS, Cho JY, Choi Y. Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single-center experience. Surg Endosc. 2016;30(2):638–48.
pubmed: 26091992
Morise Z, Ciria R, Cherqui D, Chen KH, Belli G, Wakabayashi G. Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci. 2015;22(5):342–52.
pubmed: 25663288
Harada N, Maeda T, Yoshizumi T, Ikeda T, Kayashima H, Ikegami T, et al. Laparoscopic liver resection is a feasible treatment for patients with hepatocellular carcinoma and portal hypertension. Anticancer Res. 2016;36(7):3489–97.
pubmed: 27354613
Goh EL, Chidambaram S, Ma S. Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes. Int J Surg. 2018;50:35–42.
pubmed: 29284151
Cai X, Liang X, Yu T, Liang Y, Jing R, Jiang W, et al. Liver cirrhosis grading Child-Pugh class B: a Goliath to challenge in laparoscopic liver resection? Prior experience and matched comparisons. Hepatobiliary Surg Nutr. 2015;4(6):391–7.
pubmed: 26734623
pmcid: 4689684
Kawaguchi Y, Fuks D, Kokudo N, Gayet B. Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg. 2018;267(1):13–7.
pubmed: 28187043
Popescu I, Campeanu I. Surgical anatomy of the liver and liver resection. Brisbane 2000 Terminology. Chirurgia (Bucharest). 2009;104(1):7–10.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
pubmed: 19638912
Bagante F, Ruzzenente A, Beal EW, Campagnaro T, Merath K, Conci S, et al. Complications after liver surgery: a benchmark analysis. HPB (Oxford). 2019;21(9):1139–49.
pubmed: 30718185
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083–107.
pubmed: 19757444
pmcid: 3472075
Sekhon JS. Multivariate and propensity score matching software with automated balance optimization: the matching package for R. J Stat Softw. 2011;42(7):1–52.
van Gulik T. Open versus laparoscopic resection for liver tumours. HPB (Oxford). 2009;11(6):465–8.
pubmed: 19816609
pmcid: 2756632
Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg. 2009;250(5):825–30.
pubmed: 19916210
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg. 2015;261(4):619–29.
pubmed: 25742461
Gruttadauria S, Tropea A, Pagano D, Guarini A, Liotta R, Ling T, et al. Mini-Invasive Approach Contributes To Expand The Indication For Liver Resection For Hepatocellular Carcinoma Without Increasing The Incidence Of Posthepatectomy Liver Failure And Other Perioperative Complications: A Single-Center Analysis. J Laparoendosc Adv Surg Tech A. 2016;26(6):439–46.
pubmed: 27110678
Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscara C, Scotti M, et al. Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg. 2016;103(7):871–80.
pubmed: 27029597
Di Sandro S, Danieli M, Ferla F, Lauterio A, De Carlis R, Benuzzi L, et al. The current role of laparoscopic resection for HCC: a systematic review of past ten years. Transl Gastroenterol Hepatol. 2018;3:68.
pubmed: 30363804
pmcid: 6182043
Amato B, Aprea G, De Rosa D, Milone M, di Domenico L, Amato M, et al. Laparoscopic hepatectomy for HCC in elderly patients: risks and feasibility. Aging Clin Exp Res. 2017;29(Suppl 1):179–83.
pubmed: 27914024
Gil E, Kwon CHD, Kim JM, Choi GS, Heo JS, Cho W, et al. Laparoscopic liver resection of hepatocellular carcinoma with a tumor size larger than 5 cm: review of 45 cases in a tertiary institution. J Laparoendosc Adv Surg Tech A. 2017;27(8):799–803.
pubmed: 28080205
Cipriani F, Fantini C, Ratti F, Lauro R, Tranchart H, Halls M, et al. Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients? Surg Endosc. 2018;32(2):617–26.
pubmed: 28717870
Ciria R, Gomez-Luque I, Ocana S, Cipriani F, Halls M, Briceno J, et al. A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for hepatocellular carcinoma: updated results from the European guidelines meeting on laparoscopic liver surgery, Southampton, UK, 2017. Ann Surg Oncol. 2019;26(1):252–63.
pubmed: 30390167
Bruix J, Sherman M, Practice guidelines committee, american association for the study of liver diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42(5):1208–36.
pubmed: 16250051
Bruix J, Sherman M, American association for the study of liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.
pubmed: 21374666
pmcid: 3084991
Santambrogio R, Kluger MD, Costa M, Belli A, Barabino M, Laurent A, et al. Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh’s A cirrhosis: is clinical evidence of portal hypertension a contraindication? HPB (Oxford). 2013;15(1):78–84.
pubmed: 23216782
Capussotti L, Ferrero A, Vigano L, Muratore A, Polastri R, Bouzari H. Portal hypertension: contraindication to liver surgery? World J Surg. 2006;30(6):992–9.
pubmed: 16736327
Lim C, Osseis M, Lahat E, Doussot A, Sotirov D, Hemery F, et al. Safety of laparoscopic hepatectomy in patients with hepatocellular carcinoma and portal hypertension: interim analysis of an open prospective study. Surg Endosc. 2019;33(3):811–20.
pubmed: 30003350
Sahara K, Paredes AZ, Tsilimigras DI, Hyer JM, Merath K, Wu L, et al. Impact of liver cirrhosis on perioperative outcomes among elderly patients undergoing hepatectomy: the effect of minimally invasive surgery. J Gastrointest Surg. 2019;23(12):2346–53.
pubmed: 30719676
Pawlik TM. Minimally invasive oncologic surgery. Surg Oncol Clin N Am. 2019;28(1):xiii–xiv.
Cloyd JM, Pawlik TM. Minimally invasive hepatopancreatobiliary surgery: where do we go from here? Surg Oncol. 2018;27(1):A2–A4.
pubmed: 29397259
Fuentes JM, Hanly EJ, Aurora AR, De Maio A, Shih SP, Marohn MR, et al. CO
pubmed: 16368488
Bachman SL, Hanly EJ, Nwanko JI, Lamb J, Herring AE, Marohn MR, et al. The effect of timing of pneumoperitoneum on the inflammatory response. Surg Endosc. 2004;18(11):1640–4.
pubmed: 15580445
Goldfarb M, Brower S, Schwaitzberg SD. Minimally invasive surgery and cancer: controversies part 1. Surg Endosc. 2010;24(2):304–34.
pubmed: 19572178
Clinical Outcomes of Surgical Therapy Study Group; Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9.
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84.
pubmed: 15992696