Minimally invasive versus open liver resection for hepatocellular carcinoma in the setting of portal vein hypertension: results of an international multi-institutional analysis

Andrea Ruzzenente, Fabio Bagante, Francesca Ratti, Laura Alaimo, Hugo P. Marques, Silvia Silva, Olivier Soubrane, Itaru Endo, Kota Sahara, Eliza W. Beal, Vincent Lam, George A. Poultsides, Eleftherios A. Makris, Irinel Popescu, Sorin Alexandrescu, Guillaume Martel, Aklile Workneh, Thomas J. Hugh, Alfredo Guglielmi, Luca AldrighettiTimothy M. Pawlik*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared. Methods: Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized. Results: Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08]. Conclusion: An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.

Original languageEnglish
Pages (from-to)3360-3371
Number of pages12
JournalAnnals of Surgical Oncology
Volume27
Issue number9
Early online date9 Apr 2020
DOIs
Publication statusPublished - Sep 2020
Externally publishedYes

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