Perioperative and long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with well-preserved liver function and cirrhotic background: a propensity score matching study

Abstract The number of elderly patients with hepatocellular carcinoma (HCC) requiring surgical treatment has been continuously increasing. This study aimed to examine the safety and feasibility of laparoscopic liver resection (LLR) versus open liver resection (OLR) for HCC in elderly patients at our institution in Japan.Between 2010 and 2018, LLR and OLR were performed in 80 and 138 elderly patients (>70 years) who were diagnosed with HCC, respectively. Propensity score matching (PSM) analysis with covariates of baseline characteristics was applied. Intra- and postoperative data were evaluated in both groups.After PSM, 56 patients who underwent LLR and OLR, respectively, were compared. No significant differences in demographic, clinical data, and operative times were observed. Blood loss (OLR: 327 mL; LLR: 50 mL; P< 0.001), length of postoperative hospital stay (OLR: 12 days; LLR: 7 days; P< 0.001), and time to start oral intake (OLR: 2 days; LLR: 1 day; P< 0.001) were significantly lower and shorter in the LLR group than in the OLR group. The incidence of complications over Clavien-Dindo class IIIa was similar between both groups.Our results suggest that advanced age alone is not a contraindication, and LLR can be a treatment option for elderly patients with HCC.

Download Full-text

Short-Term Outcomes of Laparoscopic Versus Open Liver Resection for Hepatocellular Carcinoma in Elderly Patients: A Propensity Score Matching Analysis

10.21203/rs.3.rs-118776/v2 ◽

2021 ◽

Author(s):

Kazuteru Monden ◽

Hiroshi Sadamori ◽

Masayoshi Hioki ◽

Satoshi Ohno ◽

Norihisa Takakura

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Oral Intake ◽

Short Term ◽

Open Liver Resection ◽

Propensity Score Matching Analysis ◽

Baseline Characteristics

Abstract BackgroundThe number of elderly patients with hepatocellular carcinoma (HCC) requiring surgical treatment has been continuously increasing. This study aimed to examine the safety and feasibility of laparoscopic liver resection (LLR) versus open liver resection (OLR) for HCC in elderly patients at our institution in Japan.MethodsBetween 2010 and 2018, LLR and OLR were performed in 80 and 138 elderly patients (aged > 70 years) who were diagnosed with HCC, respectively. Propensity score matching (PSM) analysis with covariates of baseline characteristics was applied. Intra- and postoperative data were evaluated in both groups.ResultsAfter PSM, 56 patients who underwent LLR and OLR, respectively, were compared. No significant differences in demographic, clinical data, and operative times were observed. Blood loss (OLR: 327 mL, LLR: 50 mL [P < 0.001]), length of postoperative hospital stay (OLR: 12 days, LLR: 7 days [P < 0.001]), and time to start oral intake (OLR: 2 days, LLR: 1 day [P < 0.001]) were significantly lower and shorter in the LLR group than in the OLR group. The incidence of complications over Clavien-Dindo class IIIa was similar between both groups.ConclusionsOur results suggest that advanced age alone is not a contraindication, and LLR can be a treatment option for elderly patients with HCC.Trial registration: retrospectively registered

Download Full-text

Long-term outcomes of laparoscopic liver resection for hepatocellular carcinoma: A propensity score matched analysis of a high-volume North American center

Surgery ◽

10.1016/j.surg.2021.10.017 ◽

2021 ◽

Author(s):

Tommy Ivanics ◽

Marco PAW. Claasen ◽

Madhukar S. Patel ◽

Luckshi Rajendran ◽

Chaya Shwaartz ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

North American ◽

Laparoscopic Liver Resection ◽

High Volume ◽

Long Term Outcomes

Download Full-text

Effect of Severity of Liver Cirrhosis on Surgical Outcomes of Hepatocellular Carcinoma After Liver Resection and Microwave Coagulation

Frontiers in Oncology ◽

10.3389/fonc.2021.745615 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jiang Li ◽

Hai-su Tao ◽

Jian Li ◽

Wen-qiang Wang ◽

Wei-wei Sheng ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Liver Resection ◽

Liver Function ◽

Subgroup Analysis ◽

Surgical Outcomes ◽

Long Term Outcomes ◽

Microwave Coagulation ◽

Small Hcc

BackgroundLiver resection (LR) and percutaneous microwave coagulation therapy (PMCT) are both considered as radical treatments for small hepatocellular carcinoma (HCC). However, it is still unclear whether to select LR or PMCT in HCC patients with different degrees of liver cirrhosis. The purpose of this study was to compare the efficacy of LR and PMCT in the treatment of solitary and small HCC accompanied with different degrees of liver cirrhosis.MethodsIn this study, 230 patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function were retrospectively reviewed. Among these patients, 122 patients underwent LR, and 108 received PMCT. The short- and long-term outcomes were compared between these two procedures. Severity of liver cirrhosis was evaluated by using clinical scoring system (CSS) as previously published. Subgroup analysis based on CSS was performed to evaluate the effect of severity of liver cirrhosis on surgical outcomes after LR and PMCT.ResultsThere was no mortality within 90 days in both groups. Major complications were significantly more frequent in the LR group than in the PMCT group (18.8% vs. 4.6%, p<0.001). However, LR provided better surgical outcomes than PMCT. The 5-year overall survival (OS) rates for the LR and PMCT groups were 65.2% and 42%, respectively (p=0.006), and the corresponding disease-free survival (DFS) rates were 51.7% and 31.5%, respectively (p=0.004). Nevertheless, subgroup analysis showed that PMCT provided long-term outcomes that were similar to LR and lower surgical complications in HCC patients with CSS score≥4.ConclusionsLR may provide better OS and DFS rates than PMCT for patients with solitary HCC lesions ≤ 3 cm and Child-Pugh A liver function irrespective of liver cirrhosis. PMCT should be viewed as the optimal treatment for solitary and small HCC with severe cirrhosis.

Download Full-text

Commentary on “Long-term outcomes of laparoscopic liver resection for hepatocellular carcinoma: A propensity score matched analysis of a high-volume North American center”

Surgery ◽

10.1016/j.surg.2021.12.002 ◽

2022 ◽

Author(s):

Wong Hoi She ◽

Albert C.Y. Chan

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Propensity Score ◽

North American ◽

Laparoscopic Liver Resection ◽

High Volume ◽

Long Term Outcomes

Download Full-text

Hepatectomy Provides Good Long-Term Outcomes for Hepatocellular Carcinoma Patients With Portal Hypertension: A Propensity Score Matching Analysis

10.21203/rs.3.rs-92573/v1 ◽

2020 ◽

Author(s):

Xiwen Wu ◽

Wei Chen ◽

Bin Chen ◽

Wenxuan Xie ◽

Shutong Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Portal Hypertension ◽

Propensity Score ◽

Propensity Score Matching ◽

Venous Invasion ◽

Long Term Outcomes ◽

Propensity Score Matching Analysis ◽

Initial Hepatectomy ◽

Baseline Characteristics

Abstract Background: The role of hepatectomy in hepatocellular carcinoma (HCC) with portal hypertension (PH) remains controversial. This study aimed to evaluate the effect of hepatectomy on overall survival (OS) of HCC patients with PH.Methods: A total of 1651 HCC initially treated with hepatectomy were retrospectively reviewed and divided into PH group (n=157) or non-PH group (n=1494). Propensity score matching (PSM) was conducted to match the baseline characteristics of the PH group and non-PH group. Results: The PH group presented a similar OS (p=0.29) and recurrence free survival (RFS) (p=0.83) compared with non-PH group after initial hepatectomy before PSM. After PSM processing, the baseline characteristics were highly comparable for both groups (133 patients in each group). The PH group also presented a similar OS (p=0.81) and RFS (p=0.65) compared with non-PH group after initial hepatectomy. After PSM, multivariate analysis identified tumor size (>5 cm) (p=0.02), macro-venous invasion (p < 0.001), AST (>37 U/L) (p =0.008) as independent risk factors for OS.Conclusions: Hepatectomy provides good long-term outcomes for HCC patients with PH. PH should not be regarded as a contraindication for hepatectomy in HCC patients.

Download Full-text