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Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis

  • Hepatobiliary Tumors
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Abstract

Background

Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared.

Methods

Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized.

Results

Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08].

Conclusion

An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Verona, Verona, Italy

    Andrea Ruzzenente MD, Fabio Bagante MD, Laura Alaimo MD & Alfredo Guglielmi MD

  2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Fabio Bagante MD, Eliza W. Beal MD & Timothy M. Pawlik MD, MPH, PhD, FACS

  3. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Francesca Ratti MD & Luca Aldrighetti MD

  4. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques MD & Silvia Silva MD

  5. Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    Olivier Soubrane MD

  6. Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan

    Itaru Endo MD & Kota Sahara MD

  7. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Vincent Lam MD

  8. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides MD & Eleftherios A. Makris MD

  9. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu MD & Sorin Alexandrescu MD

  10. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel MD & Aklile Workneh MD

  11. Department of Surgery, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia

    Thomas J. Hugh MD

  12. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA

    Timothy M. Pawlik MD, MPH, PhD, FACS

Authors
  1. Andrea Ruzzenente MD
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  2. Fabio Bagante MD
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  21. Timothy M. Pawlik MD, MPH, PhD, FACS
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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Dr. Bagante’s research is supported by the International Hepato-Pancreato-Biliary Association (IHPBA) Kenneth Warren Fellowship 2017–2018. Andrea Ruzzenente and Fabio Bagante shared first authorship. Alfredo Guglielmi, Luca Aldrighetti, and Timothy M. Pawlik shared senior authorship.

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Ruzzenente, A., Bagante, F., Ratti, F. et al. Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis. Ann Surg Oncol 27, 3360–3371 (2020). https://doi.org/10.1245/s10434-020-08444-3

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