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Journal of Gastrointestinal Surgery

, Volume 23, Issue 6, pp 1157–1165 | Cite as

Preoperative Prognosticators of Safe Laparoscopic Hepatocellular Carcinoma Resection in Advanced Cirrhosis: a Propensity Score Matching Population-Based Analysis of 1799 Western Patients

  • Eduardo A. Vega
  • Onur C. Kutlu
  • Katharina Joechle
  • Nestor De La Cruz
  • Dicken Ko
  • Claudius ConradEmail author
2018 SSAT Quick Shot Presentation

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.

Keywords

Hepatocellular carcinoma Laparoscopic Cirrhosis Propensity score 

Abbreviations

HCC

Hepatocellular carcinoma

HR

Hazard ratio

LLR

Laparoscopic liver resection

NCDB

National Cancer Database

OLR

Open liver resection

OS

Overall survival

Notes

Acknowledgements

The authors thank Stephanie Deming for her invaluable editorial support.

Author Contributions

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

Final approval of the version to be published: all authors

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4139_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 14 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Surgery, Miller School of MedicineUniversity of MiamiMiamiUSA
  3. 3.Department of Surgery, Saint Elizabeth Medical CenterTufts University School of MedicineBrightonUSA

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