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Safety of laparoscopic hepatectomy in patients with hepatocellular carcinoma and portal hypertension: interim analysis of an open prospective study

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Abstract

Background

The laparoscopic approach might increase the number of cirrhotic patients with hepatocellular carcinoma (HCC) indicated for liver resection, otherwise contraindicated due to portal hypertension. The goal of this study was to confirm the safety of laparoscopic liver resection (LLR) in patients with portal hypertension.

Methods

This prospective, single-center, open study (ClinicalTrials.gov ID: NCT02145013) included all consecutive cirrhotic patients who underwent LLR for HCC from 2014 to 2017. Short-term outcomes were compared between patients with and without clinically significant portal hypertension (CSPH, defined by hepatic venous pressure gradient ≥ 10 mmHg).

Results

The study population included 45 patients, comprising 27 patients (60%) in the no CSPH group and 18 patients (40%) in the CSPH group. All planned procedures could be performed. The two groups did not differ in the extent of resection, transfusion, duration of clamping, and need for conversion. Overall, the 90-day mortality and severe morbidity rates were nil. Moderate morbidity was significantly higher in the CSPH group (39 vs. 4%, p = 0.01); however, the two groups did not differ in the rate of unresolved liver decompensation. Intensive care unit and hospital stays were significantly longer in the CSPH group. At 2 years, overall survival was 77% in the no CSPH group and 100% in the CSPH group (p = 0.17), and recurrence-free survival was 55% in the no CSPH group and 79% in the CSPH group (p = 0.10).

Conclusion

LLR is safe in BCLC 0-A patients with CSPH, with no mortality and good short-term outcomes. Re-evaluation of the BCLC guidelines is needed.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France

    Chetana Lim, Michael Osseis, Eylon Lahat, Alexandre Doussot, Dobromir Sotirov, Chady Salloum & Daniel Azoulay

  2. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Besançon, France

    Alexandre Doussot

  3. Medical Informatics Department, Henri Mondor Hospital, Créteil, France

    Francois Hemery

  4. Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Créteil, France

    Marc Lantéri-Minet

  5. Department of Hepatology, Henri Mondor Hospital, Créteil, France

    Cyrille Feray

  6. Université Paris-Est UPEC, Créteil, France

    Daniel Azoulay

  7. INSERM, U955, Créteil, France

    Daniel Azoulay

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  1. Chetana Lim
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  2. Michael Osseis
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  3. Eylon Lahat
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Correspondence to Daniel Azoulay.

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Dr. Chetana Lim, Dr. Michael Osseis, Dr. Eylon Lahat, Dr. Alexandre Doussot, Dr. Dobromir Sotirov, Dr. Francois Hemery, Dr. Marc Lantéri-Minet, Pr. Cyrille Feray, Dr. Chady Salloum, and Pr. Daniel Azoulay have no conflicts of interest or financial ties to disclose.

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Lim, C., Osseis, M., Lahat, E. et al. Safety of laparoscopic hepatectomy in patients with hepatocellular carcinoma and portal hypertension: interim analysis of an open prospective study. Surg Endosc 33, 811–820 (2019). https://doi.org/10.1007/s00464-018-6347-1

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