Abstract
Background
The safety and oncologic outcomes of patients with advanced cirrhosis undergoing laparoscopic liver resection (LLR) compared to open resection (OLR) for hepatocellular carcinoma (HCC) remain unclear.
Methods
Patients with HCC resection during 2010–2014 were identified from the National Cancer Database. Patients with severe fibrosis; single lesions; M0; and known grade, margin status, tumor size, length of hospital stay, 30- and 90-day mortality, 30-day readmission, surgical approach, and complete follow-up were included. A 1:1 propensity score matching analysis of LLR:OLR was performed. Prognostic effect of LLR was assessed by multivariable Cox proportional hazards model.
Results
A total of 1799 hepatectomy patients (minor (n = 491, 27.3%); major (n = 1308, 72.7%)) were included. Of 193 (10.7%) LLR patients, 190 were eligible for matching. The LLR vs OLR did not differ for patient characteristics, resection margin status, and 30-day (p = 0.141), 90-day mortality (p = 0.121), or 30-day readmission (p = 0.784). Median hospital stay was shorter for LLR (6 vs 8 days, p = 0.001). Median overall survival (OS) was similar for LLR vs OLR (44.2 and 39.5 months, respectively, p = 0.064). Predictors of worse OS were older age (hazard ratio (HR) 1.04, p = 0.034), > 2 comorbidities (HR 1.29, p = 0.012), grade 3–4 disease (HR 1.81, p = 0.025), N1 disease (HR 1.04, p = 0.048), and R1 margins (HR 1.34, p = 0.002). After adjustment for confounders, LLR vs OLR was not a significant risk factor for OS (HR 1.14, 95% CI 0.76–1.71, p = 0.522).
Conclusion
While LLR in advanced cirrhosis for patients with HCC proved safe, optimal patient selection based on the preoperatively available factors comorbidities, age, degree of underlying liver disease, and high-quality oncologic surgery will determine long-term survival.
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Abbreviations
- HCC:
-
Hepatocellular carcinoma
- HR:
-
Hazard ratio
- LLR:
-
Laparoscopic liver resection
- NCDB:
-
National Cancer Database
- OLR:
-
Open liver resection
- OS:
-
Overall survival
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The authors thank Stephanie Deming for her invaluable editorial support.
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Substantial contributions to:
- The conception or design of the work:
Eduardo A. Vega, MD; Onur C. Kutlu, MD; Katharina Joechle, MD; Nestor De La Cruz, MD; Dicken Ko, MD; Claudius Conrad, MD, PhD
- The acquisition, analysis, or interpretation of data for the work:
Eduardo A. Vega, MD; Onur C. Kutlu, MD; Katharina Joechle, MD; Nestor De La Cruz, MD; Dicken Ko, MD; Claudius Conrad, MD, PhD
Drafting the work or revising it critically for important intellectual content: all authors
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59th Society for Surgery of the Alimentary Tract Annual Meeting, 2018, Washington, DC.
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Vega, E.A., Kutlu, O.C., Joechle, K. et al. Preoperative Prognosticators of Safe Laparoscopic Hepatocellular Carcinoma Resection in Advanced Cirrhosis: a Propensity Score Matching Population-Based Analysis of 1799 Western Patients. J Gastrointest Surg 23, 1157–1165 (2019). https://doi.org/10.1007/s11605-019-04139-7
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DOI: https://doi.org/10.1007/s11605-019-04139-7