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Safety and feasibility of laparoscopic liver resection for hepatocellular carcinoma with clinically significant portal hypertension: a propensity score-matched study

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Abstract

Background

The presence of clinically significant portal hypertension (CSPH) remains a relative contraindication to liver resection for patients with resectable hepatocellular carcinoma (HCC). The goal of this study was to explore whether a laparoscopic approach could extend the indications for hepatectomy to patients with PH.

Method

Patients who underwent laparoscopic liver resection (LLR) from February 2016 to September 2019 performed by a single medical team were included in this study. We analyzed the surgical and oncological outcomes between groups with and without CSPH before and after propensity score matching (PSM).

Result

We enrolled 156 patients divided into two groups according to the presence (CSPH, n = 26) or absence (non-CSPH, n = 130) of CSPH. CSPH group was associated with more clinical signs of liver dysfunction (p < 0.05). After PSM (n = 48 patients), the CSPH group tended to have a longer postoperative hospital stay (p = 0.054); however, there was no difference in operation time (p = 0.329), blood loss volume (p = 0.392), transfusion rates (p = 0.701), rate of conversion to open surgery (p = 0.666), surgical margin (p = 0.306), surgical mortality (n = 0), or comprehensive complication index (p = 0.844) between the two groups. The median follow-up time for the entire cohort was 19.6 months (range 0.2–40.6 months). The 3-year overall survival rate was 62.9% in the CSPH group and 84.3% in the non-CSPH group (p = 0.1090), and results were similar after PSM (p = 0.5734).

Conclusions

LLR is safe and feasible for HCC with PH. The introduction of minimally invasive surgery, represented by LLR, can appropriately expand the indications for hepatectomy.

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Abbreviations

HCC:

Hepatocellular carcinoma

CSPH:

Clinically significant portal hypertension

LLR:

Laparoscopic liver resection

PSM:

Propensity score matched

HBV:

Hepatitis B virus

BCLC:

Barcelona Clinic Liver Cancer

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

OS:

Overall survival

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

ICG-R15:

Indocyanine green retention rate at 15 min

HVPG:

Hepatic venous pressure gradient

CCI:

Comprehensive complication index

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

INR:

International normalized ratio

IQR:

Interquartile range

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Acknowledgement

We thank Jane Charbonneau, DVM, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac) for editing the English text of a draft of this manuscript.

Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 81827804) and the Zhejiang Major Medical Science and Technology Plan supported by National Health Commission of China (Grant No. WKJ-ZJ-2030).

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Authors and Affiliations

  1. Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China

    Junhao Zheng, Xu Feng, Yuelong Liang, Jingwei Cai, Zhaoqi Shi, Mubarak Ali Kirih, Liye Tao & Xiao Liang

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  1. Junhao Zheng
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  2. Xu Feng
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Correspondence to Xiao Liang.

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Xiao Liang, Junhao Zheng, Xu Feng, Yuelong Liang, Jingwei Cai, Zhaoqi Shi, Mubarak Ali Kirih, and Liye Tao have no conflict of interest or financial ties to disclose.

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Zheng, J., Feng, X., Liang, Y. et al. Safety and feasibility of laparoscopic liver resection for hepatocellular carcinoma with clinically significant portal hypertension: a propensity score-matched study. Surg Endosc 35, 3267–3278 (2021). https://doi.org/10.1007/s00464-020-07763-6

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