Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis

Minimally invasive liver surgery (MILS) has been slowly introduced in the past two decades and today represents a major weapon in the fight against HCC, for several reasons. This narrative review conveys the major emerging concepts in the field. The rise in metabolic-associated steatotic liver disease (MASLD)-related HCC means that patients with significant cardiovascular risk will benefit more profoundly from MILS. The advent of efficacious therapy is leading to conversion from non-resectable to resectable cases, and therefore more patients will be able to undergo MILS. In fact, resection outcomes with MILS are superior compared to open surgery both in the short and long term. Furthermore, indications to surgery may be further expanded by its use in Child B7 patients and by the use of laparoscopic ablation, a curative technique, instead of trans-arterial approaches in cases not amenable to radiofrequency. Therefore, in a promising new approach, multi-parametric treatment hierarchy, MILS is hierarchically superior to open surgery and comes second only to liver transplantation.

Section: Does Mils Improve Post-resection Outcomes?mentioning

confidence: 77%

What Is the Role of Minimally Invasive Liver Surgery in Treating Patients with Hepatocellular Carcinoma on Cirrhosis?

Vitale,

Angelico,

Sensi

et al. 2024

“…This effect remains unclear, but it has also been observed in other patient cohorts, such as cirrhotic patients. Indeed, a meta-analysis of more than 4000 patients operated on in VL for hepatocarcinoma showed a reduction in 5-year all-cause mortality [ 20 ]. Another systematic review showed that a reduction in postoperative complications has a long-term effect on both OS and DFS [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…After the groups were matched, we ran a diagnostic balancing analysis to see how well they matched. We opted to run regression models in which we additionally adjusted the impact for the same covariates of matching variables because the balance of matching was not ideal (one to one) for each variable [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Bizzoca

Zupo

Castellana

et al. 2022

Background: Minimally invasive methods in colorectal surgery offer unquestionable advantages, especially in the context of obesity. The current study addresses the lack of scientific evidence on the long-term oncologic safety of video-laparoscopic (VL) approaches in excess-weight CRC patients undergoing surgery. Methods: We retrospectively analyzed a surgical database consisting of 138 CRC patients undergoing VL (n = 87, 63%) and open CRC surgery (n = 51, 37%). To reduce selection bias, a propensity score matching was applied as a preliminary step to balance the comparison between the two surgery groups, i.e., VL and open surgery. Data from patients treated by the same surgeon were used.to minimize bias. Additional Cox regression models were run on the matched sample (N = 98) to explore the observed benefits of VL surgery in terms of overall and cancer-free survival. The nonparametric Kaplan-Meier method was used to compare the two surgical approaches and assess the likelihood of survival and cancer relapse. Results: The study sample was mostly male (N = 86, 62.3%), and VL outnumbered open surgery (63% versus 37%). Both before and after the matching, the VL-allocated group showed better overall survival (p < 0.01) with comparable cancer-free survival over more than five years of median observation time (66 months). Kaplan Meier survival probability curves corroborated the VL significant protective effect on survival (HR of 0.32; 95% CI: 0.13 to 0.81) even after adjusting for major confounding factors (age, gender, comorbidity index, BMI, tumor localization, tumor staging, tumor grading, clearance, CRM). Findings on oncologic performance by tumor relapse were comparable but lacked significance due to the small number of events observed. Conclusions: Comparing CRC surgical approaches, VL allocation showed comparable cancer-free survival but also a better performance on overall mortality than open surgery over more than five years of median observation.

“…At present, solitary lesions (≤5 cm) located in segments 2 through 6, which was the most acceptable LLR indication, as well as laparoscopic major liver resection, have been performed [7,8,14,[16][17][18][19][20]. With these LLR developments, perioperative outcomes are better in patients with HCC who underwent LLR than those who underwent OLR, with no difference in long-term outcomes [16,17,[21][22][23], whereas a recent systematic review and meta-analysis study indicated better long-term outcomes after minimal invasive liver resection (MILR), including LLR (48 articles) and robot-assisted liver resection (RALR, 2 articles) for HCC than OLR among the recently published data [24]. The pooled analysis revealed an 18% decrease in diseasespecific 3-year mortality after MILR (almost, LLR) compared with OLR (Figure 1), and the sensitivity analysis of contemporary studies from 2010 to 2019 revealed a significantly lower 5-year all-cause mortality and 3-year disease-specific mortality in MILR compared to OLR.…”

Section: Introductionmentioning

confidence: 99%

“…The studies shown in this figure can be found as references[6,21,23,. Reprinted/adapted with permission from Ref [24]…”

mentioning

confidence: 99%

Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection

Tanaka¹,

Kubo²,

Ishizawa³

2023

Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection (OLR) for HCC. However, the prevalence of liver cirrhosis, obesity, the elderly, HCC recurrence (repeat liver resection), and major resection must be considered for LLR for HCC. Some systematic reviews, meta-analysis studies, and large cohort studies indicated that LLR is technically feasible for selected patients with HCC with these factors that led to less intraoperative blood loss, fewer transfusions and postoperative complication incidences, and shorter hospital stays than OLR. Furthermore, some reported LLR prevents postoperative loss of independence. No difference was reported in long-term outcomes among patients with HCC who underwent LLR and OLR; however, some recent reports indicated better long-term outcomes with LLR. In recent years, robot-assisted liver resection (RALR) has gradually become popular, and its short- and long-term results for HCC are not different from those of LLR. Additionally, RALR is expected to become the mainstay of minimally invasive surgery in the future.