Effect of surgical delay on survival outcomes in patients undergoing curative resection for primary hepatocellular carcinoma: Inverse probability of treatment weighting using propensity scores and propensity score adjustment

Kabir, Tousif; Syn, Nicholas; Ramkumar, M.; Yeo, Edwin; Teo, Jin‐Yao; Koh, Ye‐Xin; Lee, Ser‐Yee; Cheow, Peng‐Chung; Chow, Pierce K.H.; Chung, Alexander Y. F.; Ooi, London Lucien; Chan, Chung Yip; Goh, Brian K. P.

doi:10.1016/j.surg.2019.09.022

Cited by 11 publications

(30 citation statements)

References 24 publications

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“…While most previous studies have performed PSM based on pre‐operative parameters of qualitative hepatic function (Indocyanine Green testing, albumin, bilirubin, prothrombin time, platelets and so on), the present study has focused on clinicopathological factors of increasing significance in today's context. With better patient selection and pre‐operative optimisation, most patients with physiologically significant derangements in hepatic synthetic and excretory function are now excluded from MH 15–19,21 . With the advent of MILR, factors such as cirrhosis, tumour size, multifocality, previous liver resections and concomitant abdominal operations (non‐cholecystectomy) are now of greater concern to attending surgeons, all of which are addressed in this study.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

Chin

Linn

Cheong

et al. 2021

ANZ Journal of Surgery

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Background The utility of minimally‐invasive liver resection (MILR) for deep centrally located tumours (CLT) remains controversial. We aimed to review our institution's experience and outcomes with minimally invasive central hepatectomy (CH) and right anterior sectionectomy (RAS) for CLT in a propensity score‐matched (PSM) analysis. Methods Retrospective review of a prospectively maintained surgical database revealed 23 patients who underwent MILR (6 CH, 17 RAS) and 53 patients who underwent open liver resection (OLR; 24 CH, 29 RAS) for CLT. PSM in a 1:1 ratio identified two groups of patients with similar baseline clinicopathological characteristics. Peri‐operative outcomes were then compared. Results There was one laparoscopic‐assisted, one robot‐assisted and two laparoscopic‐converted‐open procedures in the MILR cohort. Across the unmatched cohort, there was only one mortality (MILR) and five patients with major morbidity (all OLR). MILR was associated with a longer operating time (P < 0.001), but shorter post‐operative hospital stay (P = 0.002) and decreased morbidity (P = 0.018) in the unmatched cohort. Examination of peri‐operative outcomes after PSM revealed that MILR was similarly associated with a longer operating time (P = 0.001) and shortened post‐operative hospital stay (P = 0.043). OLR was associated with a significantly reduced application of Pringle manoeuvre (P = 0.004). There were no significant differences between MILR and OLR with regards to blood loss, blood transfusions, morbidity and margin status in the PSM analysis. Conclusion MILR for CLT is safe and feasible when performed by experienced surgeons. It is associated with shorter hospital stays but at the expense of longer operation times and more frequent application of Pringle manoeuver.

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Section: Discussionmentioning

confidence: 99%

“…The selection criteria, pre‐operative workup and surgical technique applied in our institution for both MILR and OLR have been reported previously 11,12,18–22 . MILR was first performed in SGH in 2006 and has since been systematically advocated by several senior surgeons since 2012.…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

Chin

Linn

Cheong

et al. 2021

ANZ Journal of Surgery

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“…A cohort study of 12102 patients with HCC conducted by Croome et al showed that patients with TTS more than 60 days after hepatectomy had a lower risk of death and a higher 5-year survival rate [14] , The authors speculate that patients with severe disease and a higher risk of late death may undergo early surgery, while patients with lower invasiveness will receive surgery later. And receive a more comprehensive preoperative evaluation.The Tousif Kabir et al study was the most similar to this study regarding the design [17] , in which they used time cut-off points of 30, 60, and 90 days in the analysis, and compared OS between each group and reported no signi cant differences. We also only reviewed the relationship between the different TTS and OS according to the different time cut-off points, but the selection of the time cut-off point was different.…”

Section: Discussionmentioning

confidence: 95%

“…The pathological results showed that 9.5% of the patients had cirrhosis, 27.6% had microvascular invasion, 12.1% had venous thromboembolism, and 88.4% were highly differentiated. Severe complications occurred in 2.6% of the patients, with a median hospital stay of 18 (14)(15)(16)(17)(18)(19)(20)(21)(22) days. The median OS of patients was 37 (23.4-57.6) months (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Effect of Delayed Surgical Resection of Primary Hepatocellular Carcinoma on Survival Outcomes In Elderly Patients and Prediction of Clinical Models

Liang

et al. 2021

Preprint

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Background: The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients.Methods: A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed.Results: A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival.Conclusion: We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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“…These facts cannot be overseen, also, cancer is a bigger problem than COVID-19 from patient's perspective. Table 1 summarises various studies addressing the impact of time to treatment initiation or delaying surgeries on cancer survival [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Keeping these concerns in mind, some guidelines have recommended a possible triage ( Table 2) to offer surgeries, even during the course of an active pandemic, for certain precarious malignancies who are known to have rapid progression.…”

Section: Cancer Surgery In Covid-19 Outbreakmentioning

confidence: 99%

To Do or Not to Do?—A Review of Cancer Surgery Triage Guidelines in COVID-19 Pandemic

Shinde

Naik

Shinde

et al. 2020

Indian J Surg Oncol

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COVID-19 pandemic has emerged as a global health emergency involving more than 200 countries so far. The number of affected population is on rising, so is the mortality. This crisis has overwhelmed the healthcare infrastructures in many affected countries. Due to overall rising cancer incidence and specific concerns, a cohort of cancer patients forms a distinct subset of the population in whom a correct and timely treatment has a huge impact on the outcome. During this period, oncology care is definitely affected owing to many factors like lockdowns, reduced beds and deferral of elective cases to halt the spread of the pandemic. Surgery remains the best line of defence in many solid organ tumours especially in early stage and is potentially curative. China, the source of this pandemic, has taken more than 3 months to enter the post transitional phase of this pandemic. Deferring cancer surgeries for this long period may have a direct impact on the long-term outcomes of cancer patients. Many surgical oncology associations across the globe have come up with triage guidelines for surgical care of cancer patients; however, these are based on expert opinion rather than actual data. Herein, we intend to review these guidelines with respect to the risk of disease progression in cancer patients. In the absence of actual data on cancer surgery care during this pandemic, clinical decisions should be based on careful consideration of disease-related and patient-related factors. While some of the cancer surgeries can be safely delayed for some time, how long we can delay surgeries safely cannot be answered/ explained by any means. Thorough evaluation and discussion by an expert and experienced multidisciplinary team appears to be the most effective way forward.

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Effect of surgical delay on survival outcomes in patients undergoing curative resection for primary hepatocellular carcinoma: Inverse probability of treatment weighting using propensity scores and propensity score adjustment

Cited by 11 publications

References 24 publications

Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity‐score‐matched analysis

Effect of Delayed Surgical Resection of Primary Hepatocellular Carcinoma on Survival Outcomes In Elderly Patients and Prediction of Clinical Models

To Do or Not to Do?—A Review of Cancer Surgery Triage Guidelines in COVID-19 Pandemic

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