We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved?
- Authors
Vivarelli, Marco; Mocchegiani, Federico; Wakabayashi, Taiga; Gaudenzi, Federico; Nicolini, Daniele; Al-Omari, Malek A.; Conte, Grazia; Borgheresi, Alessandra; Agostini, Andrea; Rossi, Roberta; Fujiyama, Yoshiki; Giovagnoni, Andrea; Wakabayashi, Go; Benedetti Cacciaguerra, Andrea
- Abstract
Simple Summary: This international experience investigated the clinical impact of round ligament (RL) preservation during minimally invasive liver surgery (MILS) in cirrhotic patients with mild portal hypertension and borderline liver function. During open surgery, the RL is usually divided in order to facilitate the exposition and mobilization of the liver. On the contrary, during MILS, the surgeons have the chance to preserve the RL when feasible, potentially explaining why there is less post-hepatectomy liver failure reported in Literature in comparison with the traditional open approach. This concept may encourage the use of MILS in patients with hepatocellular carcinoma and cirrhosis, thus expanding indications for radical treatments and for increasing the so-called salvageability (chance of repeated liver resections). Furthermore, this concept may be helpful for patients potentially eligible for future liver transplantation who might benefit from a "surgical downstaging strategy". Post-hepatectomy liver failure (PHLF) represents a major cause of morbidity and mortality after liver resection. The factors related to PHLF are represented not only by the volume and function of the future liver remnant but also by the severity of portal hypertension. The aim of this study was to assess whether the preservation of the round ligament (RL) may mitigate portal hypertension, thus decreasing the risk of PHLF and ascites in cirrhotic patients while undergoing minimally invasive liver surgery (MILS). All the cirrhotic patients who underwent MILS for HCC from 2016 to 2021 in two international tertiary referral centers were retrospectively analyzed, comparing cases with the RL preserved vs. those with the RL divided. Only patients with cirrhosis ≥ Child A6, portal hypertension, and ICG-R15 > 10% were included. Main postoperative outcomes were compared, and the risk factors for postoperative ascites (severe PHLF, grade B/C) were investigated through a logistic regression. After the application of the selection criteria, a total of 130 MILS patients were identified, with 86 patients with the RL preserved and 44 with the RL divided. The RL-preserved group showed lower incidences of severe PHLF (7.0% vs. 20.5%, p = 0.023) and ascites (5.8% vs. 18.2%, p = 0.026) in comparison with the RL-divided group. After uni/multivariate analysis, the risk factors related to postoperative ascites were RL division and platelets < 92 × 103/µL, calculated with ROC analysis. The preservation of the round ligament during MILS may mitigate portal hypertension, preventing PHLF and ascites in cirrhotic patients with borderline liver function.
- Subjects
PREVENTION of surgical complications; LIGAMENT surgery; MINIMALLY invasive procedures; CONNECTIVE tissues; MULTIVARIATE analysis; CIRRHOSIS of the liver; TERTIARY care; RETROSPECTIVE studies; ACQUISITION of data; SURGICAL complications; SURGERY; PATIENTS; TREATMENT effectiveness; ASCITES; MEDICAL referrals; MEDICAL records; DESCRIPTIVE statistics; LIVER transplantation; LOGISTIC regression analysis; HEPATECTOMY; LIVER failure; DISEASE risk factors; EVALUATION
- Publication
Cancers, 2024, Vol 16, Issue 2, p364
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16020364