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25-09-2024 | Liver Resection

Open, laparoscopic liver resection and percutaneous thermal ablation in elderly patients with hepatocellular carcinoma: outcomes and therapeutic strategy

Authors: Antonella Delvecchio, Maria Conticchio, Annachiara Casella, Francesca Ratti, Maximiliano Gelli, Ferdinando Massimiliano Anelli, Alexis Laurent, Giulio Cesare Vitali, Paolo Magistri, Emanuele Felli, Taiga Wakabayashi, Patrick Pessaux, Tullio Piardi, Fabrizio Di Benedetto, Nicola de’Angelis, Javier Briceño-Delgado, Antonio Rampoldi, Rene Adam, Daniel Cherqui, Luca Aldrighetti, Riccardo Memeo

Published in: Surgical Endoscopy

Abstract

Background

Liver resection and percutaneous thermal ablation (PTA) are considered curative option for hepatocellular carcinoma (HCC).

This study aims to compare short- and long-term outcomes between open liver resection (OLR), laparoscopic liver resection (LLR), and PTA in elderly patients with single HCC and to define a liver map for therapeutic strategy according to HCC location and size.

Methods

A multicenter retrospective study was conducted in 10 European Hospital Center, including 239 consecutive liver resection (OLR and LLR) and PTA in elderly patients ≥ 70 years old with single HCC ≤ 30 mm. Perioperative data and long-term oncological outcomes were collected and compared between groups before and after propensity score matching.

Results

A total of 239 patients were enrolled, distributed as follows: 61 in the ORL group, 88 in the LLR group, and 90 in the PTA group. The hospital stay was longer in OLR and LLR groups compared to the PTA group (6, 5 and 3 days, respectively, p < 0.05). Morbidity was lower in the PTA group compared to the OLR group (11 vs. 26%, respectively, p < 0.05). Overall survival (OS) at 5 years was significantly higher in the OLR and LLR groups compared to the PTA group (82, 81, and 34%, respectively, p < 0.001). Disease-free survival (DFS) at 5 years was also significantly higher in the ORL and LLR groups compared to the PTA group (66, 50 and 20%, respectively, p < 0.001). These results were also confirmed after a propensity score matching analysis between surgery group (OLR and LLR) and the PTA group. PTA was the most used treatment for subcapsular and deep HCC not in contact with vascular structures compared to OLR and LLR.

Conclusion

PTA in elderly patients ensures a shorter hospital stay and lower morbidity but worst survival compared to liver resection.

Graphical abstract

Ward EM, Sherif AE, Neill OS, Hughes M, Ireland H, Wigmore SJ, Adair A (2021) Clinical outcomes of ablation compared with resection for single hepatocellular carcinoma lesions, as a primary treatment or bridging to liver transplantation: a retrospective comparative study. Ann Transplant. https://doi.org/10.12659/AOT.931980CrossRefPubMedPubMedCentral

Goh EL, Chidambaram S, Ma S (2018) Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes. Int J Surg 50:35–42. https://doi.org/10.1016/j.ijsu.2017.12.021CrossRefPubMed

Torzilli G, Belghiti J, Kokudo N, Takayama T, Capussotti L, Nuzzo G, Vauthey J-N, Choti MA, De Santibanes E, Donadon M, Morenghi E, Makuuchi M (2013) A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers. Ann Surg 257:929–937. https://doi.org/10.1097/SLA.0b013e31828329b8CrossRefPubMed

Spolverato G, Vitale A, Ejaz A, Kim Y, Maithel SK, Cosgrove DP, Pawlik TM (2015) The relative net health benefit of liver resection, ablation, and transplantation for early hepatocellular carcinoma. World J Surg 39:1474–1484. https://doi.org/10.1007/s00268-015-2987-7CrossRefPubMed

Delvecchio A, Inchingolo R, Laforgia R, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, De Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R (2021) Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients. World J Gastrointest Surg 13:1696–1707. https://doi.org/10.4240/wjgs.v13.i12.1696CrossRefPubMedPubMedCentral

Viganò L, Laurenzi A, Solbiati L, Procopio F, Cherqui D, Torzilli G (2018) Open liver resection, laparoscopic liver resection, and percutaneous thermal ablation for patients with solitary small hepatocellular carcinoma (≤ 30 mm) Review of the literature and proposal for a therapeutic strategy. Dig Surg 35(4):359–371CrossRefPubMed

Conticchio M, Inchingolo R, Delvecchio A, Laera L, Ratti F, Gelli M, Anelli F, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R (2021) Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria. World J Gastroenterol 27:2205–2218. https://doi.org/10.3748/wjg.v27.i18.2205CrossRefPubMedPubMedCentral

Couinaud C (1980) Definition of hepatic anatomical regions and their value during hepatectomy. Chir—Mem l’Academie Chir 106(2):103–108

Strasberg SM, Phillips C (2013) Use and dissemination of the Brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg 257:377–382. https://doi.org/10.1097/SLA.0b013e31825a01f6CrossRefPubMed

10.

Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, De Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed

11.

Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey J-N, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724. https://doi.org/10.1016/j.surg.2010.10.001CrossRefPubMed

12.

Llovet JM, Brú C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. https://doi.org/10.1055/s-2007-1007122CrossRefPubMed

13.

Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan TJ, Shaw AD, Thacker JKM, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF (2018) American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg 126:1883–1895. https://doi.org/10.1213/ANE.0000000000002743CrossRefPubMed

14.

Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, Rossi S (2008) Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology. https://doi.org/10.1002/hep.21933CrossRefPubMed

15.

Nakashima T, Kojiro M (1986) Pathologic characteristics of hepatocellular carcinoma. Semin Liver Dis 6:259–266. https://doi.org/10.1055/s-2008-1040608CrossRefPubMed

16.

Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative short-term benefits of laparoscopic liver resection. Ann Surg 263:761–777. https://doi.org/10.1097/SLA.0000000000001413CrossRefPubMed

17.

Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762. https://doi.org/10.1097/00000658-200012000-00004CrossRefPubMedPubMedCentral

18.

Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Hilal MA, Belli G, Kwon CHD, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in morioka. Ann Surg. https://doi.org/10.1097/SLA.0000000000001184CrossRefPubMed

19.

Hilal MA, Aldrighetti ÃL, Dagher I, Aroori S, Belli ÃÃG, Besselink M, Briceno J, Gayet B, Hondt MD, Lesurtel M, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van DR, White S, Halls MC, Cipriani ÃF, Van Der PM, Ciria R, Barkhatov L, Gomez-luque Y, Ocana-garcia S, Cook A, Buell J, Clavien P, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor ÃM, Van GT, Wakabayashi G, Asbun ÃH (2017) The Southampton consensus guidelines for laparoscopic liver surgery. Ann Surg. https://doi.org/10.1097/SLA.0000000000002524CrossRefPubMed

20.

Yoon Y-S, Han H-S, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637. https://doi.org/10.1007/s00464-009-0823-6CrossRefPubMed

21.

Badawy A, Seo S, Toda R, Fuji H, Fukumitsu K, Ishii T, Taura K, Kaido T, Uemoto S (2019) A propensity score-based analysis of laparoscopic liver resection for liver malignancies in elderly patients. J Investig Surg. https://doi.org/10.1080/08941939.2017.1373170CrossRef

22.

Campion EW (1994) The oldest old. N. Engl. J. Med.

23.

(2016) WHO | Proposed working definition of an older person in Africa for the MDS Project. WHO

24.

Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Oldervoll L, Ravasco P, Solheim TS, Strasser F, de Schueren M, Preiser JC, Bischoff SC (2021) ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr 40:2898–2913. https://doi.org/10.1016/j.clnu.2021.02.005CrossRefPubMed

25.

Orimo H (2006) Reviewing the definition of elderly. Jpn J Geriatr 6(3):149–158

26.

Story DA (2008) Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol 23(3):375–379CrossRef

27.

Ruarus AH, Vroomen LGPH, Geboers B, van Veldhuisen E, Puijk RS, Nieuwenhuizen S, Besselink MG, Zonderhuis BM, Kazemier G, de Gruijl TD, van Lienden KP, de Vries JJJ, Scheffer HJ, Meijerink MR (2020) Percutaneous irreversible electroporation in locally advanced and recurrent pancreatic cancer (PANFIRE-2): a multicenter, prospective, single-arm, phase II study. Radiology 294:212–220. https://doi.org/10.1148/radiol.2019191109CrossRefPubMed

28.

de Angelis N, Abdalla S, Bianchi G, Memeo R, Charpy C, Petrucciani N, Sobhani I, Brunetti F (2018) Robotic versus laparoscopic colorectal cancer surgery in elderly patients: a propensity score match analysis. J Laparoendosc Adv Surg Tech 28:1334–1345. https://doi.org/10.1089/lap.2018.0115CrossRef

29.

De Blasi V, Memeo R, Adam R, Goéré D, Cherqui D, Regimbeau JM, Rivoire M, Perotto LO, Navarro F, Sa Cunha A, Pessaux P (2018) Major hepatectomy for colorectal liver metastases in patients aged over 80: a propensity score matching analysis. Dig Surg 35:333–341. https://doi.org/10.1159/000486522CrossRefPubMed

30.

Feng Q, Chi Y, Liu Y, Zhang L, Liu Q (2015) Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: a meta-analysis of 23 studies. J Cancer Res Clin Oncol 141:1–9. https://doi.org/10.1007/s00432-014-1708-1CrossRefPubMed

31.

Chen M-S, Li J-Q, Zheng Y, Guo R-P, Liang H-H, Zhang Y-Q, Lin X-J, Lau WY (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328. https://doi.org/10.1097/01.sla.0000201480.65519.b8CrossRefPubMedPubMedCentral

32.

Lee HW, Lee JM, Yoon J-H, Kim YJ, Park J-W, Park S-J, Kim SH, Yi N-J, Suh K-S (2018) A prospective randomized study comparing radiofrequency ablation and hepatic resection for hepatocellular carcinoma. Ann Surg Treat Res 94:74. https://doi.org/10.4174/astr.2018.94.2.74CrossRefPubMedPubMedCentral

33.

Xu X-L, Liu X-D, Liang M, Luo B-M (2018) Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology 287:461–472. https://doi.org/10.1148/radiol.2017162756CrossRefPubMed

34.

Lai C, Jin R, Liang X, Cai X (2016) Comparison of laparoscopic hepatectomy, percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma. J Zhejiang Univ B 17:236–246. https://doi.org/10.1631/jzus.B1500322CrossRef

35.

Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X (2014) Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS ONE 9:e84484. https://doi.org/10.1371/journal.pone.0084484CrossRefPubMedPubMedCentral

36.

Ueno S, Sakoda M, Kubo F, Hiwatashi K, Tateno T, Baba Y, Hasegawa S, Tsubouchi H (2009) Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria. J Hepatobiliary Pancreat Surg 16:359–366. https://doi.org/10.1007/s00534-009-0069-7CrossRefPubMed

37.

Liu PH, Hsu CY, Hsia CY, Lee YH, Huang YH, Chiou YY, Lin HC, Huo TI (2016) Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤ 2 cm in a propensity score model. Ann Surg. https://doi.org/10.1097/SLA.0000000000001178CrossRefPubMed

38.

Huang J, Yan L, Cheng Z, Wu H, Du L, Wang J, Xu Y, Zeng Y (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252:903–912. https://doi.org/10.1097/SLA.0b013e3181efc656CrossRefPubMed

39.

Lü M, Kuang M, Liang L, Xie X, Peng B, Liu G, Li D, Lai J, Li S (2006) Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial. Zhonghua Yi Xue Za Zhi 86:801–805PubMed

40.

Feng K, Yan J, Li X, Xia F, Ma K, Wang S, Bie P, Dong J (2012) A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma. J Hepatol 57:794–802. https://doi.org/10.1016/j.jhep.2012.05.007CrossRefPubMed

41.

Cheung TT, Dai WC, Tsang SHY, Chan ACY, Chok KSH, Chan SC, Lo CM (2016) Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110 patients with liver cirrhosis: a propensity analysis at a single center. Ann Surg 264(4):612–620CrossRefPubMed

42.

Lee S, Kang TW, Cha DI, Song KD, Lee MW, Rhim H, Lim HK, Sinn DH, Kim JM, Kim K (2018) Radiofrequency ablation vs. surgery for perivascular hepatocellular carcinoma: propensity score analyses of long-term outcomes. J Hepatol 69:70–78. https://doi.org/10.1016/j.jhep.2018.02.026CrossRefPubMed

43.

Cucchetti A, Piscaglia F, Cescon M, Colecchia A, Ercolani G, Bolondi L, Pinna AD (2013) Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol 59:300–307. https://doi.org/10.1016/j.jhep.2013.04.009CrossRefPubMed

44.

Fonseca AZ (2014) Complications of radiofrequency ablation of hepatic tumors: frequency and risk factors. World J Hepatol 6:107. https://doi.org/10.4254/wjh.v6.i3.107CrossRefPubMedPubMedCentral

45.

Kim YJ, Raman SS, Yu NC, Busuttil RW, Tong M, Lu DSK (2008) Radiofrequency ablation of hepatocellular carcinoma: can subcapsular tumors be safely ablated? Am J Roentgenol 190:1029–1034. https://doi.org/10.2214/AJR.07.2293CrossRef

46.

Gaia S, Ciruolo M, Ribaldone DG, Rolle E, Migliore E, Mosso E, Vola S, Risso A, Fagoonee S, Saracco GM, Carucci P (2021) Higher efficiency of percutaneous microwave (MWA) than radiofrequency ablation (RFA) in achieving complete response in cirrhotic patients with early hepatocellular carcinoma. Curr Oncol 28:1034–1044. https://doi.org/10.3390/curroncol28020101CrossRefPubMedPubMedCentral

Title: Open, laparoscopic liver resection and percutaneous thermal ablation in elderly patients with hepatocellular carcinoma: outcomes and therapeutic strategy
Authors: Antonella Delvecchio
Maria Conticchio
Annachiara Casella
Francesca Ratti
Maximiliano Gelli
Ferdinando Massimiliano Anelli
Alexis Laurent
Giulio Cesare Vitali
Paolo Magistri
Emanuele Felli
Taiga Wakabayashi
Patrick Pessaux
Tullio Piardi
Fabrizio Di Benedetto
Nicola de’Angelis
Javier Briceño-Delgado
Antonio Rampoldi
Rene Adam
Daniel Cherqui
Luca Aldrighetti
Riccardo Memeo
Publication date: 25-09-2024
Publisher: Springer US
Keywords: Liver Resection
Liver Resection
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-024-11269-w

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Keynote webinar | Spotlight on modern management of frailty

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Open, laparoscopic liver resection and percutaneous thermal ablation in elderly patients with hepatocellular carcinoma: outcomes and therapeutic strategy

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical abstract

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Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions