Hepatitis C positive black patients present with hepatocellular carcinoma at earlier stages of liver disease

Abstract

However, it is unclear if the technical advantages of the robotic platform result in improved clinical outcomes compared to those following laparoscopic hepatic resection. Methods: Patients undergoing laparoscopic or robotic hepatectomy between 2009 and 2018 were included. Ninety-day morbidity and mortality, as well as length of stay, readmission, operative time, conversion rate and estimated blood loss were compared between the two approaches using bivariate and multivariate logistic regression analysis. Propensity score analysis was also performed to adjust for differences between the two groups. Results: Out of 203 minimally invasive cases, 58 (28.6%) robotic procedures were performed. Resection of 3 segments (9.7% vs. 1.7%, p=0.05) and tumor size 5 cm (23.2% vs. 7.7%, p=0.015) were more common in the laparoscopic group. Superior segment resections (12.1% vs. 3.5%, p=0.019), biliary malignancy (22.4% vs. 8.3%, p=0.05) and hepatic pedicle lymph node dissection (19% vs. 1.4%, P < 0.001) were more common in the robotic group. The use of hand-assistance (2.8% vs. 0%), conversion to open (12.4% vs. 10.3%), estimated blood loss (mean, 260 ml vs. 237 ml), length of hospital stay (mean 3.7 day vs. 3.3 day), readmission (8.3% vs. 10.3%), Clavien-Dindo Class III complications (11.7% vs. 10.3%) and mortality (1.7% vs. 1.4%) were not different between the two groups (P>0.05). Robotic procedures were 50 min longer on average (mean, 265 min vs. 215 min, p=0.028). These findings were persistent on a multivariate logistic regression analysis that adjusted for potential confounders.<br>In a propensity score-matched cohort with balanced intraoperative and preoperative characteristics (N=37 in each arm) , hand-assistance (2.7% vs. 0%), estimated blood loss (314 vs. 213 ml), length of hospital stay (mean, 3.9 vs. 3.0 days), readmission (5.4% vs. 8.1%), operative time (226 vs. 253 min), Clavien Class III complications (16.2% vs. 10.8%) and mortality (2.7% vs. 2.7%) were not different between laparoscopic and robotic procedures; however, conversion rate was higher in laparoscopic procedures (18.9% vs. 0%, p=0.005). Conclusion: Robotic hepatectomy is associated with longer operative time and lower conversion rate compared to laparoscopic hepatectomy, but overall is not associated with improved clinical outcomes. The robotic platform is associated with increased use for hepatic pedicle lymph node dissection and resection of superior segment liver lesions.

Racial disparities in hepatocellular carcinoma

“…In this issue of Cancer , Shaltiel and colleagues deliver a thoughtful investigation of racial differences in HCC presentation 5 . By using a modern series of patients from a high‐volume academic institution, the authors compared Black and non‐Black patients who had a history of hepatitis C and were diagnosed with HCC.…”

“…It is also increasingly important to take a translational approach to clinical and health services research. Shaltiel et al have performed a thorough analysis that identifies a discrete racial disparity in HCC presentation 5 . Armed with this understanding, they suggest a targeted policy adjustment to improve outcomes.…”