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01-02-2018

Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?

Authors: Federica Cipriani, Corrado Fantini, Francesca Ratti, Roberto Lauro, Hadrien Tranchart, Mark Halls, Vincenzo Scuderi, Leonid Barkhatov, Bjorn Edwin, Roberto I. Troisi, Ibrahim Dagher, Paolo Reggiani, Giulio Belli, Luca Aldrighetti, Mohammad Abu Hilal

Published in: Surgical Endoscopy | Issue 2/2018

Abstract

Background

Evidence on the value of laparoscopic liver resections (LLR) for hepatocellular carcinoma (HCC) and severe cirrhosis is still lacking. The aim of this study is to assess surgical and oncological outcomes of LLR in cirrhotic HCC patients.

Methods

The analysis included 403 LLR for HCC from seven European centres. 333 cirrhotic and 70 non-cirrhotic patients were compared. A matched comparison was performed between 100 Child–Pugh A and 25 Child–Pugh B patients.

Results

There was no difference in blood loss (250 vs. 250 mL, p 0.465) and morbidity (28.6 vs. 26.4%, p 0.473) between cirrhotics and non-cirrhotics, and liver-specific complications were similar (12.8 vs. 12%, p 0.924). The sub-analysis revealed similar perioperative outcomes in either Child–Pugh A or B patients. Noteworthy, ascitis (11 vs. 12%, p 0.562) and liver failure (3 vs. 4%, p 0.595) were not different. ASA score (OR 1.76, p 0.034) and conversion (OR 2.99, p 0.019) were risk factors for major morbidity. Despite lower recurrence-free survival in cirrhotics (43 vs. 55 months, p 0.034), overall survival was similar to non-cirrhotic patients (84 vs. 76.5, p 0.598).

Conclusion

LLR for HCC appear equally safe in cirrhotic and non-cirrhotic patients, and the advantages can be witnessed in those with advanced cirrhosis. Severe comorbidities and conversion should be considered risk factors for complications—rather than the severity of cirrhosis and portal hypertension—when liver resection is performed laparoscopically. Such results may be of great interest to liver surgeons and hepatologists when deciding on the management of HCC within cirrhosis.

Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 30:61–74CrossRefPubMed

Cha CH, Ruo L, Fong Y, Jarnagin WR, Shia J, Blumgart LH, DeMatteo RP (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238:315–321 (discussion 321–323)PubMedPubMedCentral

Chirica M, Scatton O, Massault PP, Aloia T, Randone B, Dousset B, Legmann P, Soubrane O (2008) Treatment of stage IVA hepatocellular carcinoma. Should we reappraise the role of surgery? Arch Surg 143:538–543CrossRefPubMed

Yin L, Li H, Li AJ, Lau WY, Pan ZY, Lai EC, Wu MC, Zhou WP (2014) Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: a RCT. J Hepatol 61:82e8CrossRef

Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J, Kianmanesh R, Ng IO, Curley SA, Yamaoka Y, Lauwers GY, Vauthey JN (2005) Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 137:403–410CrossRefPubMed

Ishizawa T, Hasegawa K, Kokudo N, Sano K, Imamura H, Beck Y, Sugawara Y, Makuuchi M (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51CrossRefPubMed

Fuster J, García-Valdecasas JC, Grande L, Tabet J, Bruix J, Anglada T, Taurá P, Lacy AM, González X, Vilana R, Bru C, Solé M, Visa J (1996) Hepatocellular carcinoma and cirrhosis. Results of surgical treatment in a European series. Ann Surg 223:297–302CrossRefPubMedPubMedCentral

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46CrossRefPubMed

McPhail MJ, Scibelli T, Abdelaziz M, Titi A, Pearce NW, Abu Hilal M (2009) Laparoscopic versus open left lateral hepatectomy. Expert Rev Gastroenterol Hepatol 3:345–351CrossRefPubMed

10.

Cipriani F, Shelat VG, Rawashdeh M, Francone E, Aldrighetti L, Takhar A, Armstrong T, Pearce NW, Abu Hilal M (2015) Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes and oncologic efficiency. J Am Coll Surg 221:265–272CrossRefPubMed

11.

Ratti F, Barkhatov L, Tomassini F, Cipriani F, Kazaryan AM, Edwin B, Abu Hilal M, Troisi RI, Aldrighetti L (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30:3618–3629CrossRefPubMed

12.

Montalti R, Tomassini F, Laurent S, Smeets P, De Man M, Geboes K, Libbrecht LJ, Troisi RI (2015) Impact of surgical margins on overall and recurrence-free survival in parenchymal-sparing laparoscopic liver resections of colorectal metastases. Surg Endosc 29:2736–2747CrossRefPubMed

13.

Kazaryan AM, Røsok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25:3881–3889CrossRefPubMedPubMedCentral

14.

Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 21:732–736CrossRefPubMed

15.

Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15:818–823CrossRefPubMed

16.

Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefPubMed

17.

Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048CrossRefPubMed

18.

Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci 22:721–727CrossRefPubMed

19.

Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176CrossRefPubMed

20.

Cherqui D (2015) Laparoscopic liver resection: a new paradigm in the management of hepatocellular carcinoma? J Hepatol 63:540–542CrossRefPubMed

21.

Geller DA, Tsung A (2015) Long-term outcomes and safety of laparoscopic liver resection surgery for hepatocellular carcinoma and metastatic colorectal cancer. J Hepatobiliary Pancreat Sci 22:728–730CrossRefPubMed

22.

Abu Hilal M, Di Fabio F, Abu Salameh M, Pearce NW (2012) Oncological efficiency analysis of laparoscopic liver resection for primary and metastatic cancer: a single-center UK experience. Arch Surg 147:42–48CrossRefPubMed

23.

Kanazawa A, Tsukamoto T, Shimizu S, Kodai S, Yamazoe S, Yamamoto S, Kubo S (2013) Impact of laparoscopic liver resection for hepatocellular carcinoma with F4-liver cirrhosis. Surg Endosc 27:2592–2597CrossRefPubMed

24.

Ker CG, Chen JS, Kuo KK, Chuang SC, Wang SJ, Chang WC, Lee KT, Chen HY, Juan CC (2011) Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol. doi:10.4061/2011/596792 PubMedPubMedCentral

25.

Morise Z, Ciria R, Cherqui D, Chen KH, Belli G, Wakabayashi G (2015) Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci 22:342–352CrossRefPubMed

26.

Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646e9

27.

Martínez-Cecilia D, Cipriani F, Vishal S, Ratti F, Tranchart H, Barkhatov L, Tomassini F, Montalti R, Halls M, Troisi RI, Dagher I, Aldrighetti L, Edwin B, Abu Hilal M (2017) Laparoscopic versus open liver resection for colorectal metastases in elderly and octogenarian patients: a multicenter propensity score based analysis of short- and long-term outcomes. Ann Surg 265:1192–1200CrossRefPubMed

28.

Shelat VG, Cipriani F, Basseres T, Armstrong TH, Takhar AS, Pearce NW, Abu Hilal M (2015) Pure laparoscopic liver resection for large malignant tumors: does size matter? Ann Surg Oncol 22(Suppl 3):S1601CrossRefPubMed

29.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMed

30.

Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355CrossRefPubMed

31.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

32.

Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 (discussion 828-9)CrossRefPubMedPubMedCentral

33.

Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRefPubMed

34.

Memeo R, de’Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A, Azoulay D (2014) Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg 38:2919–2926CrossRefPubMed

35.

Truant S, Bouras AF, Hebbar M, Boleslawski E, Fromont G, Dharancy S, Leteurtre E, Zerbib P, Pruvot FR (2011) Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surg Endosc 25:3668–3677CrossRefPubMed

36.

Alemi F, Kwon E, Freise C, Kang SM, Hirose R, Stewart L, Corvera CU (2010) Hepatic surgery at a VA tertiary medical center: lessons learned. Am J Surg 200:591–595CrossRefPubMed

37.

Takahara T, Wakabayashi G, Nitta H, Hasegawa Y, Katagiri H, Takeda D, Makabe K, Sasaki A (2015) Laparoscopic liver resection for hepatocellular carcinoma with cirrhosis in a single institution. Hepatobiliary Surg Nutr 4:398–405PubMedPubMedCentral

38.

Lee JJ, Conneely JB, Smoot RL, Gallinger S, Greig PD, Moulton CA, Wei A, McGilvray I, Cleary SP (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma at a North-American Centre: a 2-to-1 matched pair analysis. HPB 17:304–310CrossRefPubMed

39.

Shehta A, Han HS, Yoon YS, Cho JY, Choi Y (2016) Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: 10-year single-center experience. Surg Endosc 30:638–648CrossRefPubMed

40.

Goh BK, Chan CY, Wong JS, Lee SY, Lee VT, Cheow PC, Chow PK, Ooi LL, Chung AY (2015) Factors associated with and outcomes of open conversion after laparoscopic minor hepatectomy: initial experience at a single institution. Surg Endosc 29:2636–2642CrossRefPubMed

41.

Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795CrossRefPubMed

42.

Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL (1999) Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 90:42–53CrossRefPubMed

43.

Dokmak S, Ftériche FS, Borscheid R, Cauchy F, Farges O, Belghiti J (2013) Liver resections in the 21st century: we are far from zero mortality. HPB 15:908–915CrossRefPubMedPubMedCentral

44.

Chen HW, Liao S, Lau WY, Wang FJ, Deng FW, Lai EC, Zhen ZJ (2015) Prognostic impact of hepatic resection for hepatocellular carcinoma: the role of the surgeon in achieving R0 resection – a retrospective cohort study. Int J Surg 13:297–301CrossRefPubMed

45.

Fan ST, Poon RT, Yeung C, Lam CM, Lo CM, Yuen WK, Ng KK, Liu CL, Chan SC (2011) Outcome after partial hepatectomy for hepatocellular cancer within the Milan criteria. Br J Surg 98:1292–1300CrossRefPubMed

46.

Yip VS, Gomez D, Tan CY, Staettner S, Terlizzo M, Fenwick S, Malik HZ, Ghaneh P, Poston G (2013) Tumour size and differentiation predict survival after liver resection for hepatocellular carcinoma arising from non-cirrhotic and non-fibrotic liver: a case-controlled study. Int J Surg 11:1078–1082CrossRefPubMed

47.

Taura K, Ikai I, Hatano E, Yasuchika K, Nakajima A, Tada M, Seo S, Machimoto T, Uemoto S (2007) Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: an analysis of 293 patients. Surgery 142:685–694CrossRefPubMed

48.

Poon RT, Fan ST, Ng IO, Lo CM, Liu CL, Wong J (2000) Different risk factors and prognosis for early and late intrahepatic recurrence after resection of hepatocellular carcinoma. Cancer 89:500–507CrossRefPubMed

49.

Llovet JM, Di Bisceglie AM, Bruix J, Kramer BS, Lencioni R, Zhu AX, Sherman M, Schwartz M, Lotze M, Talwalkar J, Gores GJ, Panel of Experts in HCC-Design Clinical Trials (2008) Design and endpoints of clinical trials in hepatocellular carcinoma. J Natl Cancer Inst 100:698–711CrossRefPubMed

Title: Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?
Authors: Federica Cipriani
Corrado Fantini
Francesca Ratti
Roberto Lauro
Hadrien Tranchart
Mark Halls
Vincenzo Scuderi
Leonid Barkhatov
Bjorn Edwin
Roberto I. Troisi
Ibrahim Dagher
Paolo Reggiani
Giulio Belli
Luca Aldrighetti
Mohammad Abu Hilal
Publication date: 01-02-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5711-x

At a glance: The STEP trials

Springer Medicine

Laparoscopic liver resections for hepatocellular carcinoma. Can we extend the surgical indication in cirrhotic patients?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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