Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey

Abstract

Background The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. Methods This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. Results Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). Conclusion Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.

Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

“…This means that less than half of HCC patients experienced an ideal outcome following LR, and emphasises that HCC patients are likely to develop postoperative complications related to underlying cirrhosis. 33,34 This study highlights the pivotal prognostic role of having an ideal outcome following LR. All TO criteria are separately acknowledged to influence the prognosis of HCC patients.…”

“… 2 Finally, all participating centres are high-volume HPB units trained to the skills of LLR. 33 In this setting, the influence of the hospital and surgeon's volume on TO could not be assessed. Nevertheless, this influence in HCC patients is acknowledged, and current examples of widespread diffusion of LLR tend to the centralisation of advanced procedures in leading hospitals.…”

“…40 Meanwhile, there are several current examples of successful nationwide implementations of the laparoscopic technique, especially regarding low-difficulty LLRs. 33,[41][42][43] Moreover, the acknowledged promising role of LLR in HCC patients requires appropriate assessment in large cohort studies. 44 As a matter of fact, this study represents 1 of the few series, which enrolled more consecutive HCC patients undergoing LLR than OLR during the study period, supporting the wide diffusion of the technique and lower selection amongst HCC patients.…”

Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic

“…Overall complication rates are 15% and 45% after minor and major hepatectomy respectively, and 4% and 20% for severe complications [19]. On cirrhotic livers, the latest retrospective AFC study recorded overall and severe complication rates of 44% and 11% respectively [20].…”

Integrative Concepts for Liver Surgery

“…Accordingly, a very recent matched-pair analysis of 282 versus 282 patients revealed less ascites production after laparoscopic compared to open liver surgery in patients with liver cirrhosis. Moreover, patients had shorter intensive care unit and in-hospital stays after laparoscopic surgery [62].…”