The Role of Salvage Transplantation in Patients Initially Treated With Open Versus Minimally Invasive Liver Surgery: An Intention‐to‐Treat Analysis

Abstract

Despite gaining wide consensus in the management of hepatocellular carcinoma (HCC), minimally invasive liver surgery (MILS) has been poorly investigated for its role in the setting of salvage liver transplantation (SLT). A multicenter retrospective analysis was carried out in 6 Italian centers on 211 patients with HCC who were initially resected with open (n = 167) versus MILS (n = 44) and eventually wait‐listed for SLT. The secondary endpoint was identification of risk factors for posttransplant death and tumor recurrence. The enrolled patients included 211 HCC patients resected with open surgery (n = 167) versus MILS (n = 44) and wait‐listed for SLT between January 2007 and December 2017. We analyzed the intention‐to‐treat survival of these patients. MILS was the most important protective factor for the composite risk of delisting, posttransplant patient death, and HCC recurrence (OR, 0.26; 95% confidence interval [CI], 0.11‐0.63; P = 0.003). MILS was also the only independent protective factor for the risk of post‐SLT patient death (OR, 0.29; 95% CI, 0.09‐0.93; P = 0.04). After propensity score matching, MILS was the only independent protective factor against the risk of delisting, posttransplant death, and HCC recurrence (OR, 0.22; 95% CI, 0.07‐0.75; P = 0.02). On the basis of the current analysis, MILS seems protective over open surgery for the risk of delisting, posttransplant patient death, and tumor recurrence. Larger prospective studies balancing liver function and tumor stage are strongly favored to better clarify the beneficial effect of MILS for HCC patients eventually referred to SLT.

The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

“…Again, the center experience in both HPB surgery and LT could have contributed to minimizing the difference in post-LT results. Nevertheless, we acknowledge that this important aspect surely requires further dedicated studies [ 32 , 33 , 34 ].…”

New frontiers in liver resection for hepatocellular carcinoma

“… 115 The laparoscopic approach was also shown to be beneficial prior to LT for HCC, with significantly reduced de-listing and death after LT when prior LR was performed laparoscopically. 116 Fluorescence-guided surgery can help identify the segmental anatomy in order to achieve proper anatomical resections. Likewise, injection of indigo-carmine into the segmental portal vein or selective Glissonian clamping for ischemic demarcation were used to identify segmental anatomy before LR.…”

“… 115 The laparoscopic approach was also shown to be beneficial prior to LT for HCC, with significantly reduced de-listing and death after LT when prior LR was performed laparoscopically. 116 …”

Erratum

“…In the article by Levi Sandri et al, 1 the collaborator study group was mistakenly omitted. The correct author listing appears as follows:…”