Laparoscopic and open liver resection for hepatocellular carcinoma with Child–Pugh B cirrhosis: multicentre propensity score-matched study

Abstract

Background Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child–Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child–Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child–Pugh B cirrhosis. Methods Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. Results Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child–Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2–243) days for laparoscopic liver resection and 18 (3–104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). Conclusion Patients without preoperative portal hypertension and Child–Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses

“…Recent studies from high volume centers have demonstrated that major liver resections via the minimally invasive approach demonstrated superior short-term outcome in terms of blood loss, transfusion requirement, complication rate and hospital stay even in patients with liver cirrhosis (8,14,17,(32)(33)(34)(35)(36). Overall survival appears to be comparable with open approach in patients with liver tumors (32)(33)(34)(35). Hence, with these encouraging results, many high-volume centers have been trying to expand the indications of MILR to patient with larger tumours and even huge tumours (14).…”

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

“…Laparoscopic/robotic resection allows adequate margins and has a reduced invasiveness with lower postoperative complications and potential non-significant impact in liver function even if there exists CSPH [59][60][61][62][63]101]. These encouraging results may induce a resection recommendation in patients who would be initially selected for ablation, but in whom the peripheral tumour location may contraindicate such approach because of risk of tract seeding if punctured without a protective rim of non-tumoral liver or risk of neighbouring organ damage [60].…”

Protective benefit of minimally invasive liver surgery for hepatocellular carcinoma prior to transplant

“…Moreover, reducing abdominal wall trauma with less resulting pain, less bleeding, and ascetic are wellknown advantages of laparoscopy. Another significant advantage of laparoscopic surgery is reducing postoperative adhesions, making subsequent surgical approaches simpler and safer [17] . The surgical indication for laparoscopy can be extended to more complex patients with more advanced liver disease.…”