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Salvage liver transplantation after laparoscopic resection for hepatocellular carcinoma: a multicenter experience

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Abstract

Liver transplantation is the ideal treatment for patients affected by early stage hepatocellular carcinoma and chronic liver disease. Considering organs shortage, alternative treatments have to be adopted to minimize the waitlist drop-out, and in case of recurrence within the accepted criteria, salvage transplantation can be considered. Surgical resection is one of the most effective treatments, with the possibility of oncological radicality and pathological analysis of the specimen. Although these theoretical advantages, surgical strategy cannot be applied to all patients because of the impaired liver function as well as the amount of parenchyma to be resected does not allow a sufficient future liver remnant. Furthermore, resection by laparotomy may lead to strong intra-abdominal adhesions in a contest of portal hypertension and, as potential consequence, increase transplantation difficulty raising morbidity. Laparoscopic liver resection is now performed as a routine procedure in tertiary referral centers, with increasing evidence of long-term results comparable to traditional surgery together with the advantages of a minimally invasive approach. In addition, with a salvage transplantation strategy that has been shown to be comparable to primary transplantation, the patient can live with his native liver avoiding an invasive procedure and long-term immunosuppression, allowing the use of liver grafts for the community. We present the results of an Italian multicenter experience of salvage liver transplantation following the recurrence of HCC initially treated by laparoscopic resection in 31 patients, performed by four referral centers. Mean operative transplantation time was 450 min, morbidity was 41.9 %, 90-days mortality was 3.2 %, and median post-operative length of stay was 17.9 days. Salvage liver transplantation after laparoscopic liver resection for HCC is comparable to open surgery in terms of operative time, oncologic radicality, morbidity and mortality, with the advantages of laparoscopic surgery.

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Authors and Affiliations

  1. Digestive and Transplant Liver Surgery Unit, S.Camillo Hospital Circonvallazione, Gianicolense 87, 00152, Rome, Italy

    Emanuele Felli, Roberto Santoro, Marco Colasanti, Pasquale Lepiane, Giovanni Vennarecci & Giuseppe Maria Ettorre

  2. Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, Via Giustiniani, 2, 35128, Padua, Italy

    Umberto Cillo, Enrico Gringeri & Michela Di Giunta

  3. Department of Medical and Surgical Sciences, Hospital Sant’Orsola-Malpighi, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy

    Antonio Daniele Pinna, Giorgio Ercolani & Marco Di Laudo

  4. Division of General Surgery and Transplantation, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

    Luciano De Carlis, Stefano Di Sandro & Andrea Lauterio

Authors
  1. Emanuele Felli
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  2. Umberto Cillo
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  3. Antonio Daniele Pinna
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  4. Luciano De Carlis
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  5. Giorgio Ercolani
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  6. Roberto Santoro
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  7. Enrico Gringeri
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  8. Stefano Di Sandro
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  9. Marco Di Laudo
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  10. Michela Di Giunta
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  11. Andrea Lauterio
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  12. Marco Colasanti
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  13. Pasquale Lepiane
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  14. Giovanni Vennarecci
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  15. Giuseppe Maria Ettorre
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Correspondence to Emanuele Felli.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Felli, E., Cillo, U., Pinna, A.D. et al. Salvage liver transplantation after laparoscopic resection for hepatocellular carcinoma: a multicenter experience. Updates Surg 67, 215–222 (2015). https://doi.org/10.1007/s13304-015-0323-2

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  • DOI: https://doi.org/10.1007/s13304-015-0323-2

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