Benefits of Laparoscopic Approach for Resection of Liver Tumors in Cirrhotic Patients.

Autor:	Le Roux F; 1 Department of Digestive Surgery, South Hospital, Amiens University Hospital , Amiens, France ., Rebibo L; 1 Department of Digestive Surgery, South Hospital, Amiens University Hospital , Amiens, France ., Cosse C; 1 Department of Digestive Surgery, South Hospital, Amiens University Hospital , Amiens, France .; 2 Medical Research Department, Research and Methodology Unit, Amiens University Hospital , Amiens, France ., Chatelain D; 3 Department of Pathology, Amiens University Hospital , Amiens, France ., Nguyen-Khac E; 4 Department of Hepatogastroenterology, Amiens University Hospital , Amiens, France ., Badaoui R; 5 Department of Anesthesiology, Amiens University Hospital , Amiens, France ., Regimbeau JM; 1 Department of Digestive Surgery, South Hospital, Amiens University Hospital , Amiens, France .; 6 Medical Research Department, EA4294, Jules Verne University of Picardie , Amiens, France .
Jazyk:	angličtina
Zdroj:	Journal of laparoendoscopic & advanced surgical techniques. Part A [J Laparoendosc Adv Surg Tech A] 2018 May; Vol. 28 (5), pp. 553-561. Date of Electronic Publication: 2018 Jan 19.
DOI:	10.1089/lap.2017.0584
Abstrakt:	Introduction: Liver resection in cirrhotic patients is associated with increased morbidity and mortality. The objective of this study was to compare short-term results of laparoscopic resection (LR) and open surgery (OS) for minor liver resection in patients with hepatocellular carcinoma (HCC) hepatocellularcarcinoma on nontumor cirrhotic liver (HCC/F4) and patients with colorectal cancer liver metastases (CRLMs) colorectal liver metastases on healthy liver (CRLM/F0). Materials and Methods: Between January 2005 and December 2014, all patients undergoing liver resection (n = 754) were included in this study. Liver resections for cholangiocarcinoma or benign tumor, major liver resection (≥3 segments), HCC on healthy liver, CRLM on cirrhotic liver, and liver resection with technically difficult accessibility (segments I, VII, and VIII) were excluded. The primary endpoint of the study was a validated composite endpoint (CEP), which included specific liver surgery complications (Clavien ≥III), allowing comparison of the postoperative course after LR versus OR for HCC/F4 patients and CRLM/F0 patients using propensity score (PS) analysis. Secondary endpoints were major postoperative morbidity according to the Clavien-Dindo classification (≥III) and intensive care unit (ICU) length of hospital stay (LOS) and overall LOS. The test group was defined as HCC/F4 patients operated by LR, and the control group was defined as HCC/F4 patients and CRLM/F0 patients operated by OS and CRLM/F0 patient operated by LR. Results: Sixty patients (38.7%) underwent LR and 95 patients (61.3%) underwent OS. Surgery was performed for CRLM in 93 patients (60%) and for HCC in 62 patients (40%). No difference was demonstrated between HCC/F4 patients and CRLM/F0 patients in the LR group in terms of the CEP (7% versus 18.1%; P = .23), while a significant difference for the CEP was observed between HCC/F4 patients and CRLM/F0 patients after OS (50% versus 21%; P = .021). A higher rate of CEP was observed for HCC/F4 patients operated by OS compared to HCC/F4 patients operated by LR (50% versus 7.8%; P = .009). No significant difference in Clavien-Dindo score ≥III was observed between HCC/F4 patients and CRLM/F0 patients operated by LR (10% versus 4.5%; P = .98). A higher postoperative ascites rate was observed for HCC/F4 patients operated by OS compared to CRLM/F0 patients operated by OS (25% versus 2.8%; P = .006). This difference was no longer observed when HCC/F4 patients were compared to CRLM/F0 operated by LR (7.8% versus 2.8%; P = .09). The postoperative mortality rate was 1.8% and was not correlated with nontumor liver or surgical approach. A shorter LOS was observed for HCC/F4 patients operated by LR compared to HCC/F4 patients operated by OS (7.53 versus 17.13; P = .011). Conclusion: The laparoscopic approach for malignant liver tumor is associated with a lower specific complication rate. LR for HCC/F4 could eliminate excess morbidity and decrease LOS in patients with cirrhotic liver.
Databáze:	MEDLINE
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