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Laparoscopic Liver Resection for Hepatocellular Carcinoma in Child–Pugh A Patients With and Without Portal Hypertension: A Multicentre Study

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Abstract

Background

Laparoscopic liver resection (LLR) may improve outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) and portal hypertension (PHT). The aim of this study was to compare the short-term outcomes after LLR for HCC in cirrhotic patients with and without PHT.

Methods

This multicentric study included 96 HCC patients who underwent LLR. Clinically significant portal hypertension (CSPH) was defined by a hepatic venous pressure gradient ≥10 mmHg. Short-term outcomes and liver-specific complications including post-hepatectomy liver failure (PHLF), ascites and encephalopathy were compared between patients with and without CSPH.

Results

Thirty-one patients (32%) had CSPH. The CSPH group had higher post-operative morbidity (52% vs. 15%; p < 0.001), PHLF (10% vs. 0%; p = 0.03) and encephalopathy (10% vs. 0%; p = 0.03). There was no difference in terms of post-operative ascites between the two groups (CSPH: 16% vs. no CPSH: 8%, p = 0.28). The length of stay was longer in patients with CSPH than in those without CSPH (6 vs. 4 days; p < 0.001).

Conclusions

The laparoscopic approach is feasible in selected HCC patients with CSPH, at the price of significant increases in liver-specific complications and length of stay.

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Authors and Affiliations

  1. Unit of Hepato-Biliary and Pancreatic Surgery, Department of General Surgery, Hospital Universitari de Girona Dr. Josep Trueta, Av de França s/n, 17007, Girona, Catalonia, Spain

    Margarida Casellas-Robert, Santiago Lopez-Ben & Joan Figueras

  2. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France

    Chetana Lim

  3. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd, Barcelona, Catalonia, Spain

    Laura Lladó & Emilio Ramos

  4. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France

    Chady Salloum & Daniel Azoulay

  5. Department of Interventional Radiology, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain

    Jaume Codina-Font

  6. Department of Computer Science, Applied Mathematics and Statistics, Universitat de Girona, Girona, Catalonia, Spain

    Marc Comas-Cufí

  7. Research Unit in Primary Care, Catalan Institute of Health, Barcelona, Catalonia, Spain

    Marc Comas-Cufí

  8. The Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina, Barcelona, Catalonia, Spain

    Marc Comas-Cufí

  9. Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Faculty of Medicine, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

    Daniel Azoulay

Authors
  1. Margarida Casellas-Robert
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  2. Chetana Lim
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  3. Santiago Lopez-Ben
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  4. Laura Lladó
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  5. Chady Salloum
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  6. Jaume Codina-Font
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  7. Marc Comas-Cufí
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  8. Emilio Ramos
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  9. Joan Figueras
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  10. Daniel Azoulay
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Contributions

MCR, CL, CS and ER participated in data collection. MCR and MCC participated in data analysis. MCR, CL, SLB, LL, JCF, ER, JF and DA participated in the writing process and manuscript revision.

Corresponding author

Correspondence to Margarida Casellas-Robert.

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Conflict of interest

Margarida Casellas-Robert, Chetana Lim, Santiago Lopez-Ben, Laura Lladó, Chady Salloum, Jaume Codina-Font, Marc Comas-Cufí, Emilio Ramos, Joan Figueras and Daniel Azoulay have nothing to disclose.

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Casellas-Robert, M., Lim, C., Lopez-Ben, S. et al. Laparoscopic Liver Resection for Hepatocellular Carcinoma in Child–Pugh A Patients With and Without Portal Hypertension: A Multicentre Study. World J Surg 44, 3915–3922 (2020). https://doi.org/10.1007/s00268-020-05687-9

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  • DOI: https://doi.org/10.1007/s00268-020-05687-9

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