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Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce.

In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared.

Methods

A retrospective inverse propensity score-weighted fashion (IPTW) case–control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed.

Results

Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62–1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54–2.6, p = 0.66).

After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence.

Conclusion

AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.

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References

  1. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69:182‑236.

    Article  Google Scholar 

  2. Xu X-F, Xing H, Han J, Li Z-L, Lau W-Y, Zhou Y-H, et al. Risk Factors, Patterns, and Outcomes of Late Recurrence After Liver Resection for Hepatocellular Carcinoma: A Multicenter Study From China. JAMA Surg. 2019;154:209‑17.

    Article  PubMed  Google Scholar 

  3. Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000;232:10‑24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109‑11.

    Article  CAS  PubMed  Google Scholar 

  5. Hao S, Fan P, Chen S, Tu C, Wan C. Anterior approach to improve the long-term outcome in patients with large-size hepatocellular carcinoma having liver resection. J Surg Oncol. 2016;114:872‑8.

    Article  PubMed  Google Scholar 

  6. Wang C-C, Jawade K, Yap AQ, Concejero AM, Lin C-Y, Chen C-L. Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg. 2010;34:1874‑8.

    Article  PubMed  Google Scholar 

  7. Chan K-M, Wang Y-C, Wu T-H, Lee C-F, Wu T-J, Chou H-S, et al. The Preference for Anterior Approach Major Hepatectomy: Experience Over 3 Decades and a Propensity Score-Matching Analysis in Right Hepatectomy for Hepatocellular Carcinoma. Medicine (Baltimore). 2015;94:e1385.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wu T-J, Wang F, Lin Y-S, Chan K-M, Yu M-C, Lee W-C. Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br J Surg. 2010;97:1070‑8.

    Article  PubMed  Google Scholar 

  9. Liu CL, Fan ST, Cheung ST, Lo CM, Ng IO, Wong J. Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg. 2006;244:194‑203.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hao S, Chen S, Tu C, Huang T. Anterior Approach to Improve the Prognosis in HCC Patients Via Decreasing Dissemination of EpCAM+ Circulating Tumor Cells. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2017;21:1112‑20.

    Article  Google Scholar 

  11. Belghiti J. Editorial perspective: Resection of large hepatocellular carcinoma using combination of liver hanging maneuver and anterior approach. World J Surg. 2010;34:1879‑80.

    Article  PubMed  Google Scholar 

  12. Nagino M, DeMatteo R, Lang H, Cherqui D, Malago M, Kawakatsu S, et al. Proposal of a New Comprehensive Notation for Hepatectomy: The « New World » Terminology. Ann Surg. 2021;274:1‑3.

    Article  PubMed  Google Scholar 

  13. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4:e297.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. Ann Surg. 2004;240:205‑13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713‑24.

    Article  PubMed  Google Scholar 

  16. Mise Y, Vauthey J-N, Zimmitti G, Parker NH, Conrad C, Aloia TA, et al. 90-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality. Ann Surg. 2015;262:1071‑8.

    Article  PubMed  Google Scholar 

  17. Hermanek P, Wittekind C. Residual tumor (R) classification and prognosis. Semin Surg Oncol. 1994;10:12‑20.

    Article  CAS  PubMed  Google Scholar 

  18. Seaman SR, White IR, Copas AJ, Li L. Combining multiple imputation and inverse-probability weighting. Biometrics. 2012;68:129‑37.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivar Behav Res. 2011;46:399‑424.

    Article  Google Scholar 

  20. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083‑107.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shimahara Y, Yamamoto N, Kobayashi N, Yamaoka Y. Anterior approach to dorsal short hepatic and right hepatic veins in a right hepatic lobectomy. Nihon Geka Hokan Arch Jpn Chir. 1996;65:13‑21.

    CAS  Google Scholar 

  22. Ozawa K. Hepatic function and liver resection. J Gastroenterol Hepatol. 1990;5:296‑309.

    Article  CAS  PubMed  Google Scholar 

  23. Lai EC, Fan ST, Lo CM, Chu KM, Liu CL. Anterior approach for difficult major right hepatectomy. World J Surg. 1996;20:314‑7; discussion 318.

    Article  CAS  PubMed  Google Scholar 

  24. Beppu T, Imai K, Okuda K, Eguchi S, Kitahara K, Taniai N, et al. Anterior approach for right hepatectomy with hanging maneuver for hepatocellular carcinoma: a multi-institutional propensity score-matching study. J Hepato-Biliary-Pancreat Sci. 2017;24:127‑36.

    Article  Google Scholar 

  25. Liu C-L, Fan S-T, Lo C-M, Tung-Ping Poon R, Wong J. Anterior Approach for Major Right Hepatic Resection for Large Hepatocellular Carcinoma. Ann Surg. 2000;232:25‑31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Nanashima A, Sumida Y, Tominaga T, Nagayasu T. Significance of liver hanging maneuver for anatomical hepatectomy in patients with a large hepatocellular carcinoma compressing intrahepatic vasculatures. Ann Hepato-Biliary-Pancreat Surg. 2017;21:188‑93.

    Article  Google Scholar 

  27. Capussotti L, Ferrero A, Russolillo N, Langella S, Lo Tesoriere R, Viganò L. Routine anterior approach during right hepatectomy: results of a prospective randomised controlled trial. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16:1324‑32.

    Article  Google Scholar 

  28. Moggia E, Rouse B, Simillis C, Li T, Vaughan J, Davidson BR, et al. Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev. 2016;10:CD010683.

    PubMed  Google Scholar 

  29. Llado L, Muñoz A, Ramos E, Torras J, Fabregat J, Rafecas A. The anterior hanging-approach improves postoperative course after right hepatectomy in patients with colorectal liver metastases. Results of a prospective study with propensity-score matching comparison. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2016;42:176‑83.

    CAS  Google Scholar 

  30. Tang J-X, Li J-J, Weng R-H, Liang Z-M, Jiang N. Anterior vs conventional approach right hepatic resection for large hepatocellular carcinoma: A systematic review and meta-analysis. World J Gastroenterol. 2017;23:7917‑29.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank Dr. Coralie Barbe for her valuable contribution to statistical analysis.

All authors have formulated their final approval of the submitted version of the manuscript.

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Authors and Affiliations

  1. Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France

    Rami Rhaiem, Perrine Zimmermann, Koceila Amroun, Ahmad Tashkandi, Tullio Piardi & Reza Kianmanesh

  2. Reims Champagne-Ardenne University, Reims, France

    Rami Rhaiem, Perrine Zimmermann, Koceila Amroun, Ahmad Tashkandi, Alexandra Heurgue, Gérard Thiefin, Tullio Piardi & Reza Kianmanesh

  3. INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Rami Rhaiem, Daniele Sommacale, Alexis Laurent, Giuliana Amaddeo, Julien Calderaro, Alain Luciani & Raffaele Brustia

  4. Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France

    Daniele Sommacale, Alexis Laurent & Raffaele Brustia

  5. Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France

    Giuliana Amaddeo

  6. Pathology Department, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France

    Julien Calderaro

  7. Department of Diagnostic Radiology, AP-HP, Hôpital Henri-Mondor, F-94010, Créteil, France

    Alain Luciani

  8. Department of Hepatology, Robert Debré University Hospital, Reims, France

    Alexandra Heurgue & Gérard Thiefin

  9. Hepatobiliary, Pancreatic and Endocrine Surgery Department, Simon Veil Hospital, Troyes, France

    Tullio Piardi

Authors
  1. Rami Rhaiem
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Contributions

Conception and design: Drs Rhaiem, Brustia, Piardi, Thiefin, Kianmanesh and Sommacale

Acquisition, analysis, or interpretation of data for the work: Drs Rhaiem, Brustia, Tashkandi, Amroun, Zimmermann, Laurent, Ammadeo, Calderaro, Luciani, Heurgue

Drafting of the work: Rhaiem, Brustia, Amroun, Ammadeo, Tashkandi, Zimmermann and Piardi

Critical revision of the manuscript: Laurent, Calderaro, Luciani, Thiefin, Heurgue, Kianmanesh and Sommacale

Statistical analysis: Rhaiem, Brustia and Amroun

Corresponding author

Correspondence to Rami Rhaiem.

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11605_2023_5741_MOESM3_ESM.jpg

Supplementary file3 (JPG 36 KB) Supplementary data 3 A: Five-years cancer-specific overall survival before (A) and after (B) IPTW.

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Rhaiem, R., Sommacale, D., Zimmermann, P. et al. Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis. J Gastrointest Surg 27, 2092–2102 (2023). https://doi.org/10.1007/s11605-023-05741-6

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