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Prognosis and safety of laparoscopic hepatectomy for BCLC stage 0/A hepatocellular carcinoma with clinically significant portal hypertension: a multicenter, propensity score-matched study

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Abstract

Background and aim

The latest Barcelona Clinic Liver Cancer (BCLC) staging system suggests considering surgery in patients with resectable BCLC stage 0/A hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH). This study aimed to evaluate the safety and short- and long-term outcomes of laparoscopic hepatectomy for BCLC stage 0/A HCC patients with CSPH.

Methods

We retrospectively reviewed the medical records of 647 HCC patients in BCLC stage 0/A who were treated at five centers between January 2010 and January 2019. Among these patients, 434 underwent laparoscopic hepatectomy, and 213 underwent open hepatectomy. We used Kaplan–Meier analysis to compare the overall survival (OS) rate and recurrence-free survival (RFS) rate between patients with and without CSPH before and after propensity score matching (PSM). Multivariate Cox regression analysis was performed to identify prognostic factors for BCLC stage 0/A patients, and subgroup analyses were also conducted.

Results

Among the 434 patients who underwent laparoscopic hepatectomy, 186 had CSPH and 248 did not. The Kaplan–Meier analysis showed that the OS and RFS rates were significantly worse in the CSPH group before and after PSM. Multivariate Cox regression analyses identified CSPH as a prognostic factor for poor OS and RFS after laparoscopic hepatectomy. However, CSPH patients treated laparoscopically had a better short- and long-term prognosis than those treated with open surgery.

Conclusions

CSPH has a negative impact on the prognosis of BCLC stage 0/A HCC patients after laparoscopic hepatectomy. Laparoscopic hepatectomy is still recommended for treatment, but careful patient selection is essential.

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Data availability

The datasets generated and/or analyzed in the current study are not publicly available [These data are used in other studies by our team] but are available from the corresponding author on reasonable request.

Abbreviations

CSPH:

Clinically significant portal hypertension

BCLC:

Barcelona clinic liver cancer

AFP:

Alpha-fetoprotein

HCC:

Hepatocellular carcinoma

RFA:

Radiofrequency ablation

PHLF:

Posthepatectomy liver failure

TACE:

Transcatheter arterial chemoembolization

OS:

Overall survival

RFS:

Recurrence-free survival

MVI:

Microvascular invasion.

HBsAg:

Hepatitis B surface antigen

ALB:

Albumin

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ALP:

Alkaline phosphatase

GGT:

γ-Glutamyl transpeptidase

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Authors and Affiliations

  1. Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China

    Feng Xia & Elijah Ndhlovu

  2. Department of Emergency Medicine, Zhongshan People’s Hospital Affiliated to Guangdong Medical University, Zhongshan, Guangdong, China

    Qiao Zhang

  3. Department of Science and Education, Shenzhen Baoan District People’s Hospital, Guangdong, China

    Jun Zheng

  4. Department of Thyroid & Breast Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi, Hubei, China

    Minggang Yuan

  5. Department of Hepatobiliary and Pancreatic Surgery, Shenzhen Longhua District People’s Hospital, Guangdong, China

    Hengyi Gao

  6. Department of Hepatobiliary and Pancreatic Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi, Hubei, China

    Guobing Xia

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  1. Feng Xia
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Corresponding author

Correspondence to Guobing Xia.

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Disclosures

Feng Xia, Qiao Zhang, Elijah Ndhlovu, Jun Zheng, Minggang Yuan, Hengyi Gao, and Guobing Xia declare no conflicts of interest.

Ethical approval

The Ethics Committees of Wuhan Tongji Hospital, Zhongshan People’s Hospital, Huangshi Central Hospital, Shenzhen Baoan District People's Hospital, and Shenzhen Longhua District People’s Hospital approved this retrospective observational study.

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All patients provided informed consent to the use and publication of their information.

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Xia, F., Zhang, Q., Ndhlovu, E. et al. Prognosis and safety of laparoscopic hepatectomy for BCLC stage 0/A hepatocellular carcinoma with clinically significant portal hypertension: a multicenter, propensity score-matched study. Surg Endosc 38, 799–812 (2024). https://doi.org/10.1007/s00464-023-10589-7

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  • DOI: https://doi.org/10.1007/s00464-023-10589-7

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