Surgical Endoscopy

, Volume 33, Issue 3, pp 811–820 | Cite as

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

  • Chetana Lim
  • Michael Osseis
  • Eylon Lahat
  • Alexandre Doussot
  • Dobromir Sotirov
  • Francois Hemery
  • Marc Lantéri-Minet
  • Cyrille Feray
  • Chady Salloum
  • Daniel AzoulayEmail author
Research Article



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.


This prospective, single-center, open study ( 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).


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).


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.


Liver resection Hepatocellular carcinoma Laparoscopic Clinically significant portal hypertension Hepatic venous pressure gradient 


Compliance with Ethical Standards


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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chetana Lim
    • 1
  • Michael Osseis
    • 1
  • Eylon Lahat
    • 1
  • Alexandre Doussot
    • 1
    • 2
  • Dobromir Sotirov
    • 1
  • Francois Hemery
    • 3
  • Marc Lantéri-Minet
    • 4
  • Cyrille Feray
    • 5
  • Chady Salloum
    • 1
  • Daniel Azoulay
    • 1
    • 6
    • 7
    Email author
  1. 1.Department of Hepatobiliary and Pancreatic Surgery and Liver TransplantationHenri Mondor HospitalCréteilFrance
  2. 2.Department of Hepatobiliary and Pancreatic Surgery and Liver TransplantationBesançonFrance
  3. 3.Medical Informatics DepartmentHenri Mondor HospitalCréteilFrance
  4. 4.Department of Anesthesia and Liver Intensive Care UnitHenri Mondor HospitalCréteilFrance
  5. 5.Department of HepatologyHenri Mondor HospitalCréteilFrance
  6. 6.Université Paris-Est UPECCréteilFrance
  7. 7.INSERM, U955CréteilFrance

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