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Preoperative transarterial chemoembolization for laparoscopic liver resection in Child A cirrhotic patients with hepatocellular carcinoma

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Abstract

Purpose

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) offers better short-term results than open surgery with similar long-term results although it is technically difficult due to the risk of bleeding.

Methods

This study included patients with HCC in Child A cirrhosis who underwent TACE before LLR between 2009 and 2019. The primary endpoint was to analyze the intraoperative and early results of this technique. We also analyzed the long-term outcomes. Patients with and without clinically significant portal hypertension (CSPH) were compared.

Results

A total of 44 cirrhotic patients with HCC were included (24 CSPH and 20 non-CSPH). The Pringle maneuver was used in two cases (4.5%), mean blood losses was 100 ml (range 50–200), and three patients (6.8%) required a blood transfusion. The degree of necrosis achieved was greater than 90% in 27 patients (61.4%). At 1, 3, and 5 years, overall survival was 97.7%, 81.5%, and 63.4%, respectively, and disease-free survival was 85.2%, 52.5%, and 34.5%, respectively. There were no statistically significant differences between non-CSPH and CSPH groups regarding intraoperative, early, and long-term outcomes.

Conclusion

In our experience, TACE could be beneficial to perform LLR in HCC Child–Pugh A patients with and without CSPH without serious complications and similar oncological outcomes.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain

    Víctor Lopez-Lopez, Roberto Brusadin, Asunción López-Conesa, Álvaro Navarro-Barrios, Valentín Cayuela, Pascual Parrilla-Paricio & Ricardo Robles-Campos

  2. Department of Interventional Radiology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain

    Antonio Capel

  3. Department of Radiology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain

    Elena Lopez-Banet

  4. Department of Surgical Pathology, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain

    Alejandro Garzón-Arana

Authors
  1. Víctor Lopez-Lopez
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  10. Ricardo Robles-Campos
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Contributions

Study conception and design: VLL, RB, ALC, AN, and RRC. Acquisition of data: VLL, RB, ALC, AC, ELB, AGA, and AN. Analysis and interpretation of data: VLL, RB, ALC, PP, and RRC. Drafting of manuscript: VLL, AC, ELB, AGA, PP, and RRC. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Ricardo Robles-Campos.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication

Code availability

The data for this project are confidential, but may be obtained with Data Use Agreements with the Massachusetts Department of Elementary and Secondary Education (DESE). Researchers interested in access to the data may contact Ricardo Robles-Campos at rirocam@um.es. It can take some months to negotiate data use agreements and gain access to the data. The author will assist with any reasonable replication attempts for 2 years following publication.

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Lopez-Lopez, V., Brusadin, R., López-Conesa, A. et al. Preoperative transarterial chemoembolization for laparoscopic liver resection in Child A cirrhotic patients with hepatocellular carcinoma. Langenbecks Arch Surg 406, 763–771 (2021). https://doi.org/10.1007/s00423-020-02056-x

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  • DOI: https://doi.org/10.1007/s00423-020-02056-x

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