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Long-Term Implications of Unplanned Conversion During Laparoscopic Liver Resection for Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Laparoscopic liver resection (LLR) is increasingly utilized for patients with hepatocellular carcinoma (HCC). However, long-term outcomes for patients requiring conversion to an open procedure during LLR have not been examined.

Methods

Patients undergoing attempted LLR for HCC were identified within the National Cancer Database. Patients undergoing successful LLR were compared with those who required unplanned conversion with regard to perioperative outcomes and overall survival (OS). Those experiencing conversion were further compared with patients who underwent planned open resection after propensity score matching.

Results

Unplanned conversion occurred in 228 (18.0%) of 1270 patients undergoing LLR. Compared with successful LLR, conversion was associated with greater length of stay (6 vs. 4 days, p < 0.001), higher readmission rates (7.8% vs. 2.6%, p = 0.001), and reduced OS (55.1 vs. 67.6 months, p = 0.074). Unplanned conversion during major hepatectomy was associated with significantly worse OS (median 35.7 months) compared with successful major and minor LLR (median not reached and 67.6 months, respectively, p = 0.004). Compared with planned open resection, similar results were noted as conversion during major LLR was associated with worse OS (median 27.3 months) compared with open major hepatectomy (median not reached; p = 0.002). Unplanned conversion was independently associated with increased mortality (hazard ratio 1.38) after adjustment in a multivariable model. Tumor size was the strongest predictor of conversion on logistic regression analysis.

Conclusions

Unplanned conversion during LLR for HCC is associated with inferior OS. This difference is most pronounced for major hepatectomy. LLR should be considered cautiously in patients with larger, more advanced tumors likely to require major resection.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Zachary E. Stiles DO, Evan S. Glazer MD, PhD, Jeremiah L. Deneve DO, David Shibata MD, Stephen W. Behrman MD & Paxton V. Dickson MD

Authors
  1. Zachary E. Stiles DO
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  2. Evan S. Glazer MD, PhD
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  3. Jeremiah L. Deneve DO
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  4. David Shibata MD
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  5. Stephen W. Behrman MD
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  6. Paxton V. Dickson MD
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Corresponding author

Correspondence to Paxton V. Dickson MD.

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All authors deny conflicts of interest pertinent to this work.

Additional information

Disclaimer: The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Stiles, Z.E., Glazer, E.S., Deneve, J.L. et al. Long-Term Implications of Unplanned Conversion During Laparoscopic Liver Resection for Hepatocellular Carcinoma. Ann Surg Oncol 26, 282–289 (2019). https://doi.org/10.1245/s10434-018-7073-6

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  • DOI: https://doi.org/10.1245/s10434-018-7073-6

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