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

Federica Cipriani, Corrado Fantini, Francesca Ratti, R Lauro, H Tranchart, M Halls, V Scuderi, L Barkhatov, B Edwin, Roberto I. Troisi, I Dagher, P Reggiani, G Belli, L Aldrighetti, M Abu Hilal

Research output: Contribution to journalArticle

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. © 2017 Springer Science+Business Media, LLC
Original languageEnglish
Pages (from-to)617-626
Number of pages10
JournalSurgical Endoscopy and Other Interventional Techniques
Volume32
Issue number2
DOIs
Publication statusPublished - 2018

Fingerprint Dive into the research topics of 'Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?'. Together they form a unique fingerprint.

  • Cite this

    Cipriani, F., Fantini, C., Ratti, F., Lauro, R., Tranchart, H., Halls, M., Scuderi, V., Barkhatov, L., Edwin, B., Troisi, R. I., 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 and Other Interventional Techniques, 32(2), 617-626. https://doi.org/10.1007/s00464-017-5711-x