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Surgical Endoscopy

, Volume 32, Issue 2, pp 617–626 | Cite as

Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?

  • Federica Cipriani
  • Corrado Fantini
  • Francesca Ratti
  • Roberto Lauro
  • Hadrien Tranchart
  • Mark Halls
  • Vincenzo Scuderi
  • Leonid Barkhatov
  • Bjorn Edwin
  • Roberto I. Troisi
  • Ibrahim Dagher
  • Paolo Reggiani
  • Giulio Belli
  • Luca Aldrighetti
  • Mohammad Abu Hilal
Article

Abstract

Background

Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients.

Methods

The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child–Pugh A and 25 Child–Pugh B patients.

Results

There was no difference in blood loss (250 vs. 250 mL, p 0.465) and morbidity (28.6 vs. 26.4%, p 0.473) between cirrhotics and non-cirrhotics, and liver-specific complications were similar (12.8 vs. 12%, p 0.924). The sub-analysis revealed similar perioperative outcomes in either Child–Pugh A or B patients. Noteworthy, ascitis (11 vs. 12%, p 0.562) and liver failure (3 vs. 4%, p 0.595) were not different. ASA score (OR 1.76, p 0.034) and conversion (OR 2.99, p 0.019) were risk factors for major morbidity. Despite lower recurrence-free survival in cirrhotics (43 vs. 55 months, p 0.034), overall survival was similar to non-cirrhotic patients (84 vs. 76.5, p 0.598).

Conclusion

LLR for HCC appear equally safe in cirrhotic and non-cirrhotic patients, and the advantages can be witnessed in those with advanced cirrhosis. Severe comorbidities and conversion should be considered risk factors for complications—rather than the severity of cirrhosis and portal hypertension—when liver resection is performed laparoscopically. Such results may be of great interest to liver surgeons and hepatologists when deciding on the management of HCC within cirrhosis.

Keywords

Laparoscopic liver resection Cirrhosis Child–Pugh Hepatocellular carcinoma Portal hypertension Risk factors for major morbidity 

Notes

Compliance with ethical standards

Disclosures

Drs. Federica Cipriani, Corrado Fantini, Francesca Ratti, Roberto Lauro, Hadrien Tranchart, Mark Halls, Vincenzo Scuderi, Leonid Barkhatov, Bjorn Edwin, Roberto Ivan Troisi, Ibrahim Dagher, Paolo Reggiani, Giulio Belli, Luca Aldrighetti, Mohammad Abu Hilal have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Federica Cipriani
    • 1
    • 2
  • Corrado Fantini
    • 3
  • Francesca Ratti
    • 2
  • Roberto Lauro
    • 4
  • Hadrien Tranchart
    • 5
  • Mark Halls
    • 1
  • Vincenzo Scuderi
    • 6
  • Leonid Barkhatov
    • 7
  • Bjorn Edwin
    • 7
    • 8
  • Roberto I. Troisi
    • 6
  • Ibrahim Dagher
    • 5
  • Paolo Reggiani
    • 4
  • Giulio Belli
    • 3
  • Luca Aldrighetti
    • 2
  • Mohammad Abu Hilal
    • 1
  1. 1.University Hospital Southampton NHS Foundation TrustSouthamptonUK
  2. 2.Hepatobiliary SurgeryIRCCS San Raffaele HospitalMilanItaly
  3. 3.General and Hepato-Pancreato-Biliary SurgeryLoreto Nuovo HospitalNaplesItaly
  4. 4.Hepatobiliary and Liver Transplant UnitIRCCS Foundation Policlinico Major HospitalMilanItaly
  5. 5.Department of Minimally Invasive Digestive SurgeryAntoine-Beclere HospitalClamartFrance
  6. 6.Department of General, Hepatobiliary and Liver Transplantation SurgeryGhent University Hospital Medical SchoolGhentBelgium
  7. 7.Intervention CentreOslo University Hospital, RikshospitaletOsloNorway
  8. 8.Institute of Clinical MedicineUniversity of OsloOsloNorway

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