Open Versus Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma Following Sequential TACE-PVE: A Multicentric Comparative Study.

Autor: Turco C; Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.; Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France., Hobeika C; Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France., Allard MA; AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Inserm U 935, Villejuif, France., Tabchouri N; Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France., Brustia R; Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France., Nguyen T; Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France., Cauchy F; Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France., Barbier L; Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France., Salamé E; Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France., Cherqui D; Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France., Vibert E; Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France., Soubrane O; Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France., Scatton O; Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.; Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France., Goumard C; Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France. claire.goumard@aphp.fr.; Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France. claire.goumard@aphp.fr.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2023 Oct; Vol. 30 (11), pp. 6615-6625. Date of Electronic Publication: 2023 Jul 02.
DOI: 10.1245/s10434-023-13752-5
Abstrakt: Background: Right hepatectomy (RH) for hepatocellular carcinoma (HCC) is ideally preceded by transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE). Laparoscopic approach improves short-term outcome and textbook outcome (TO), which reflects the "ideal" surgical outcome, after RH. However, laparoscopic RH on an underlying diseased liver and after TACE/PVE remains a challenging procedure. The aim of this study was to compare the outcomes in patients who underwent laparoscopic liver resection (LLR) or open liver resection (OLR) following TACE/PVE.
Patients and Methods: All patients with HCC who underwent RH after TACE/PVE in five French centers were retrospectively included. Outcomes were compared between the LLR group and the OLR group using propensity score matching (PSM). Quality of surgical care was defined by TO.
Results: Between 2005 and 2019, 117 patients were included (41 in LLR group, 76 in OLR group). Overall morbidity was comparable (51% versus 53%, p = 0.24). In LLR group, TO was completed in 66% versus 37% in OLR group (p = 0.02). LLR and absence of clamping were the only factors associated with TO completion [hazard ratio (HR) 4.27, [1.77-10.28], p = 0.001]. After PSM, 5-year overall survival (OS) and progression-free survival (PFS) were 55% in matched LLR versus 77% in matched OLR, p = 0.35, and 13% in matched LLR versus 17% in matched OLR, p = 0.97. TO completion was independently associated with a better 5-year OS (65.2% versus 42.5%, p = 0.007).
Conclusion: Major LLR after TACE/PVE should be considered as a valuable option in expert centers to increase the chance of TO, the latter being associated with a better 5-year OS.
(© 2023. Society of Surgical Oncology.)
Databáze: MEDLINE
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