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- Title
Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study.
- Authors
Troisi, R. I.; Berardi, G.; Morise, Z.; Cipriani, F.; Ariizumi, S.; Sposito, C.; Panetta, V.; Simonelli, I.; Kim, S.; Goh, B. K. P.; Kubo, S.; Tanaka, S.; Takeda, Y.; Ettorre, G. M.; Russolillo, N.; Wilson, G. C.; Cimino, M.; Montalti, R.; Giglio, M. C.; Igarashi, K.
- Abstract
Background: Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. Methods: Data on liver resections were gathered from 17 centres. A 1: 1 propensity score matching was performed according to 17 predefined variables. Results: Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P=0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P=0.004), less morbidity (38.0 versus 51.0 per cent respectively; P=0.041) and fewer major complications (7.0 versus 21.0 per cent; P=0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P=0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P,0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P=0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P=0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P=0.742). Conclusion: Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
- Subjects
LIVER surgery; HEPATOCELLULAR carcinoma; LAPAROSCOPIC surgery; SURVIVAL rate; OVERALL survival; CIRRHOSIS of the liver
- Publication
British Journal of Surgery, 2021, Vol 108, Issue 2, p196
- ISSN
0007-1323
- Publication type
Article
- DOI
10.1093/bjs/znaa041