Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis.

Autor: Ruzzenente A; Department of Surgery, University of Verona, Verona, Italy., Bagante F; Department of Surgery, University of Verona, Verona, Italy.; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Ratti F; Department of Surgery, Ospedale San Raffaele, Milan, Italy., Alaimo L; Department of Surgery, University of Verona, Verona, Italy., Marques HP; Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal., Silva S; Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal., Soubrane O; Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France., Endo I; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan., Sahara K; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan., Beal EW; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Lam V; Department of Surgery, Westmead Hospital, Sydney, NSW, Australia., Poultsides GA; Department of Surgery, Stanford University, Stanford, CA, USA., Makris EA; Department of Surgery, Stanford University, Stanford, CA, USA., Popescu I; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania., Alexandrescu S; Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania., Martel G; Department of Surgery, University of Ottawa, Ottawa, ON, Canada., Workneh A; Department of Surgery, University of Ottawa, Ottawa, ON, Canada., Hugh TJ; Department of Surgery, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia., Guglielmi A; Department of Surgery, University of Verona, Verona, Italy., Aldrighetti L; Department of Surgery, Ospedale San Raffaele, Milan, Italy., Pawlik TM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. tim.pawlik@osumc.edu.; Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2020 Sep; Vol. 27 (9), pp. 3360-3371. Date of Electronic Publication: 2020 Apr 09.
DOI: 10.1245/s10434-020-08444-3
Abstrakt: Background: Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared.
Methods: Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized.
Results: Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08].
Conclusion: An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.
Databáze: MEDLINE
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