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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

Surgical endoscopy, 2018-02, Vol.32 (2), p.617-626 [Periódico revisado por pares]

New York: Springer US

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  • Título:
    Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?
  • Autor: 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
  • Assuntos: Abdominal Surgery ; Gastroenterology ; Gynecology ; Hepatectomy ; Hepatology ; Laparoscopy ; Liver cancer ; Medicine ; Medicine & Public Health ; Proctology ; Surgery
  • É parte de: Surgical endoscopy, 2018-02, Vol.32 (2), p.617-626
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: 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.
  • Editor: New York: Springer US
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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