The Role of Salvage Transplantation in Patients Initially Treated With Open Versus Minimally Invasive Liver Surgery: An Intention-to-Treat Analysis

Giovanni B Levi Sandri, Quirino Lai, Matteo Ravaioli, Stefano Di Sandro, Emanuele Balzano, Duilio Pagano, Paolo Magistri, Fabrizio Di Benedetto, Massimo Rossi, Salvatore Gruttadauria, Paolo De Simone, Giuseppe M Ettorre, Luciano De Carlis, Matteo Cescon, Marco Colasanti, Gianluca Mennini, Matteo Serenari, Fabio Ferla, Giovanni Tincani, Fabrizio Di FrancescoCristiano Guidetti

Research output: Contribution to journalArticlepeer-review

Abstract

Despite gaining wide consensus in the management of hepatocellular carcinoma (HCC), minimally invasive liver surgery (MILS) has been poorly investigated for its role in the setting of salvage liver transplantation (SLT). A multicenter retrospective analysis was carried out in 6 Italian centers on 211 patients with HCC who were initially resected with open (n = 167) versus MILS (n = 44) and eventually wait-listed for SLT. The secondary endpoint was identification of risk factors for posttransplant death and tumor recurrence. The enrolled patients included 211 HCC patients resected with open surgery (n = 167) versus MILS (n = 44) and wait-listed for SLT between January 2007 and December 2017. We analyzed the intention-to-treat survival of these patients. MILS was the most important protective factor for the composite risk of delisting, posttransplant patient death, and HCC recurrence (OR, 0.26; 95% confidence interval [CI], 0.11-0.63; P = 0.003). MILS was also the only independent protective factor for the risk of post-SLT patient death (OR, 0.29; 95% CI, 0.09-0.93; P = 0.04). After propensity score matching, MILS was the only independent protective factor against the risk of delisting, posttransplant death, and HCC recurrence (OR, 0.22; 95% CI, 0.07-0.75; P = 0.02). On the basis of the current analysis, MILS seems protective over open surgery for the risk of delisting, posttransplant patient death, and tumor recurrence. Larger prospective studies balancing liver function and tumor stage are strongly favored to better clarify the beneficial effect of MILS for HCC patients eventually referred to SLT.

Original languageEnglish
Pages (from-to)878-887
Number of pages10
JournalLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Volume26
Issue number7
DOIs
Publication statusPublished - Jul 2020

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