Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?

Federica Cipriani, Corrado Fantini, Francesca Ratti, Roberto Lauro, Hadrien Tranchart, Mark Halls, Vincenzo Scuderi, Leonid Barkhatov, Bjorn Edwin, Roberto I. Troisi, Ibrahim Dagher, Paolo Reggiani, Giulio Belli, Luca Aldrighetti, Mohammad Abu Hilal

Research output: Contribution to journalArticle

19 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)617-626
Number of pages10
JournalSurgical Endoscopy
Volume32
Issue number2
DOIs
Publication statusPublished - Feb 1 2018

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Hepatocellular Carcinoma
Liver
Fibrosis
Morbidity
Survival
Liver Failure
Comorbidity
Recurrence

Keywords

  • Child–Pugh
  • Cirrhosis
  • Hepatocellular carcinoma
  • Laparoscopic liver resection
  • Portal hypertension
  • Risk factors for major morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Cipriani, F., Fantini, C., Ratti, F., Lauro, R., Tranchart, H., Halls, M., ... Abu Hilal, M. (2018). Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients? Surgical Endoscopy, 32(2), 617-626. https://doi.org/10.1007/s00464-017-5711-x

Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients? / Cipriani, Federica; Fantini, Corrado; Ratti, Francesca; Lauro, Roberto; Tranchart, Hadrien; Halls, Mark; Scuderi, Vincenzo; Barkhatov, Leonid; Edwin, Bjorn; Troisi, Roberto I.; Dagher, Ibrahim; Reggiani, Paolo; Belli, Giulio; Aldrighetti, Luca; Abu Hilal, Mohammad.

In: Surgical Endoscopy, Vol. 32, No. 2, 01.02.2018, p. 617-626.

Research output: Contribution to journalArticle

Cipriani, F, Fantini, C, Ratti, F, Lauro, R, Tranchart, H, Halls, M, Scuderi, V, Barkhatov, L, Edwin, B, Troisi, RI, Dagher, I, Reggiani, P, Belli, G, Aldrighetti, L & Abu Hilal, M 2018, 'Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?', Surgical Endoscopy, vol. 32, no. 2, pp. 617-626. https://doi.org/10.1007/s00464-017-5711-x
Cipriani, Federica ; Fantini, Corrado ; Ratti, Francesca ; Lauro, Roberto ; Tranchart, Hadrien ; Halls, Mark ; Scuderi, Vincenzo ; Barkhatov, Leonid ; Edwin, Bjorn ; Troisi, Roberto I. ; Dagher, Ibrahim ; Reggiani, Paolo ; Belli, Giulio ; Aldrighetti, Luca ; Abu Hilal, Mohammad. / Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?. In: Surgical Endoscopy. 2018 ; Vol. 32, No. 2. pp. 617-626.
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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.",
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AU - Fantini, Corrado

AU - Ratti, Francesca

AU - Lauro, Roberto

AU - Tranchart, Hadrien

AU - Halls, Mark

AU - Scuderi, Vincenzo

AU - Barkhatov, Leonid

AU - Edwin, Bjorn

AU - Troisi, Roberto I.

AU - Dagher, Ibrahim

AU - Reggiani, Paolo

AU - Belli, Giulio

AU - Aldrighetti, Luca

AU - Abu Hilal, Mohammad

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KW - Risk factors for major morbidity

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