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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina Introduction: Hepatocellular carcinoma (HCC) is one of the most common neoplasms in the world and 3rd cause of cancer related death. Hepatic resection, termodestruction and hepatic transplant are the only real therapeutics with curative intent, particularly when it concerns to tumours with 2cm or more. Organ transplant is obtained by paying the price of a higher risk of per-operative morbidity and a necessity of a lifetime immunosuppression, which allows tumoral resection and sick organ replacement. This option relays on the availability of a viable donor organ, which must be immunologically compatible. Resection surgery presents itself with a higher recurrence rate, but lower short-term morbimortality. However, it can still allow a worsening rise in hepatocellular disfunction. Therefore, looking for a reduced surgical aggression, we have been observing a rise in the use of the laparoscopic liver resection (LLR) in HCC, with advantages in short-term outcomes. Nevertheless, there is still the need to evaluate the extension of its long-term clinical and oncologic outcomes.Objectives: Using a propensity score matching (PSM), we are set to compare the peri-operative outcomes such as surgical complications, morbimortality, disease-free survival and global survival between the two groups of patients, operated by laparoscopy and via open surgery, in patients who were submitted to hepatectomy due to HCC.Methods and materials: For this study we took advantage of the patient pool from our general surgery department of Centro Hospitalar e Universitário de Coimbra (CHUC) since January 1990 until December 2019. Consequently, we selected the cases of minor hepatic resection which we separated in two groups: group 1 – patients submitted to LLR and group 2 – patients submitted to open liver resection (OLR). Propensity scores (PSs) were calculated for both, based on their demographic and clinical data, which we than run through a PSM, concluding in 30 patients in the LLR group and 101 in the OLR one. The morbidity and mortality were defined using the Dindo-Clavien classification, as for the post-hepatectomy liver failure, it was defined accordingly with the International Study Group of Liver Surgery (ISGLS). Overall survival and disease-free survival were analysed through the Kaplan-Meier and log rank methods.Results: After the PSM, in what concerns to the pre-operative characteristics, groups were well matched across the different demographic and clinical data.Relatively to the comparison between de two surgical procedures, we underline important lower transfusion values for the laparoscopic group (P |
