Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis

Belli, Giulio; Limongelli, Paolo; Fantini, Corrado; D’Agostino, Alberto; Cioffi, Luigi; Belli, Andrea; Russo, Gianluca

doi:10.1002/bjs.6680

Cited by 191 publications

(128 citation statements)

References 36 publications

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“…However, one of the reasons why the laparoscopic surgery is not generally accepted is because of the oncology outcome. In many studies, they indicated that there are no differences in disease free survival (DFS) rate and overall survival (OS) rate between laparoscopic surgery and open surgery [19][20][21][22]. Other limitation of laparoscopic surgery are tumor cell seeding or tumor recurrence through port site.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis: An Egyptian single center experience

Seleem¹,

Ali²

2017

Clin Case Rep Rev

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Section: Discussionmentioning

confidence: 99%

Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis: An Egyptian single center experience

Seleem¹,

Ali²

2017

Clin Case Rep Rev

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“…The present authors have already shown adequate long-term survival and recurrence after LLR of HCC is achieved compared with open surgery, when stratified for tumor characteristics known to be related to survival outcome [20]. …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

et al. 2011

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Background:Few data regarding survival or pattern of recurrence after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) on cirrhosis have been reported so far. Methods: A retrospective analysis of a prospectively maintained database of 109 laparoscopic interventional procedures performed for HCC in cirrhotic liver between 2000 and 2008 was conducted. Results: Sixty-five patients underwent an LLR. Morbidity rates were 20% (13/65), whereas there was only 1 death (1.5%). Reoperation was required in 2 patients. The overall mean postoperative hospital stay was 8.2 (2.6; 3–15) days. The actuarial overall 1-, 3-, and 5-year survival rates were 95, 70, and 55%, respectively, with a median overall survival of 75 months. Excluding the one hospital death, the actuarial 1-, 3-, and 5-year disease-free survival rates were 81, 62, and 32%, respectively, with a median overall disease-free survival of 42 months (95% confidence interval, CI: 18–65). On multivariate analysis, tumor grade (OR: 3.5, 95% CI: 1.1–10.7, p = 0.026) and microvascular invasion (OR: 4.9, 95% CI: 1.2–18.8, p = 0.020) resulted as independent predictors of overall survival. On multivariate analysis, gender (OR: 3.4, 95% CI: 1.1–10.2, p = 0.023), satellite tumor (OR: 4.3, 95% CI: 1.5–12.3, p = 0.006), microvascular invasion (OR: 3.3, 95% CI: 1.0–10.1, p = 0.036) and surgical margin (OR: 3.7, 95% CI: 1.0–10.1, p = 0.036) were identified as independent prognostic predictors of better disease-free survival. After a median follow-up of 29 (range 3–81) months, 31 (48%) out of 64 patients had recurrence. The cumulative recurrence rates at 1, 3, and 5 years were 19, 39, and 68%, respectively. Conclusion: This prospective observational study has confirmed the feasibility and safety of LLR in selected patients with HCC in cirrhotic liver, and proved that it can warrant long-term outcome similar to those reported with the traditional open approach.

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“…Severe blood loss or prolonged ascites after major hepatectomy, especially by open surgery, can occur by interruption of collateral circulation in the parietal wall and surrounding ligamentsin patients with liver cirrhosis [20] and may prolong the postoperative hospital stay or induce hepatic failure in some patients. However, LLR may minimize the reduction in collateral and lymphatic low caused by laparotomy and mobilization [21,22]. The beneits of LLR in liver cirrhosis include enhanced recovery, less postoperative pain, and potentially less postoperative complications.…”

Section: Liver Resection Vs Tace and Rfamentioning

confidence: 99%

Management of Hepatocellular Carcinoma in the Setting of Liver Cirrhosis

Giakoustidis¹,

Giakoustidis²

2017

Liver Cirrhosis - Update and Current Challenges

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Cirrhosis is an increasing cause of morbidity and mortality in more developed countries, being the 14th most common cause of death worldwide. Hepatocellular carcinoma (HCC) consists a signiicant health issue worldwide, responsible for more than 1 million deaths annually. The incidence and mortality rates vary across diferent geographical areas. Between 60 and 90% of HCC patients already have liver cirrhosis, atributed mainly to chronic hepatitis B and C, alcohol abuse, and non-alcoholic faty liver disease (NASH). The surgical management of HCC in the seting of liver cirrhosis with curative intent includes liver resection, ablation or microwave coagulation, and liver transplantation (LT). Liver resection in a cirrhotic liver with HCC is associated with lower survival rates compared with liver transplantation (LT), depending on the diseases' stage but on the contrary liver resection could be potentially ofered in a larger population compared to liver transplantation. One of the biggest limitations of liver resection is the risk of tumor recurrence, which is high, and it may exceed 70% 5 years after the procedure. Liver transplantation is considered the best treatment for hepatocellular carcinoma at early stages because it removes the tumor as well as the underlying cirrhotic liver.

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Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis

Abstract: Laparoscopic resection of HCC in cirrhotic liver is feasible and safe in selected patients. Adequate long-term survival and recurrence is achieved compared with open surgery, when stratified for tumour characteristics known to be related to survival outcome.

Cited by 191 publications

References 36 publications

Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis: An Egyptian single center experience

Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis: An Egyptian single center experience

Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes

Management of Hepatocellular Carcinoma in the Setting of Liver Cirrhosis

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