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Aliseda D, Zozaya G, Martí-Cruchaga P, Herrero I, Iñarrairaegui M, Argemí J, Martínez De La Cuesta A, Blanco N, Sabatella L, Sangro B, Rotellar F. The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection: A Meta-Analysis of Matched Cohort and Prospective Studies. Ann Surg 2024; 280:46-55. [PMID: 38126757 DOI: 10.1097/sla.0000000000006185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Examine portal hypertension (PHT) impact on postoperative and survival outcomes in hepatocellular carcinoma (HCC) patients after liver resection (LR), specifically exploring distinctions between indirect signs and invasive measurements of PHT. BACKGROUND PHT has historically discouraged LR in individuals with HCC due to the elevated risk of morbidity, including liver decompensation (LD). METHODS A systematic review was conducted using 3 databases to identify prospective-controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and overall survival in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: for aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method). RESULTS Nine studies involving 1124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with hepatic venous pressure gradient (HVPG) ≥10 mm Hg significantly increased the risk of overall complications, PHLF, and LD. Despite elevated risks, the procedure resulted in a 5-year overall survival rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF, and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in minimally invasive LR. CONCLUSIONS LR in the presence of indirect signs of PHT poses no increased risk of complications. Yet, in HVPG ≥10 mm Hg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. Minimally invasive approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mm Hg patients.
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Affiliation(s)
- Daniel Aliseda
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Gabriel Zozaya
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Pablo Martí-Cruchaga
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Ignacio Herrero
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Mercedes Iñarrairaegui
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Josepmaría Argemí
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Antonio Martínez De La Cuesta
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Interventional Radiology, Department of Radiology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Nuria Blanco
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Lucas Sabatella
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Bruno Sangro
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Fernando Rotellar
- HPB and Liver Transplant Unit Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
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Yu H, Zhao F, Men X, Zhu H, Yan J, Liu Z, Liu Q, Feng Y, Wang L, Meng M, Zhu Q, Zhao X. Microwave ablation versus laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension: a propensity score-matched study of postoperative liver decompensation. Eur Radiol 2024; 34:3226-3235. [PMID: 37875593 DOI: 10.1007/s00330-023-10268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES The study of postoperative liver decompensation after microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with clinically significant portal hypertension (CSPH) is still lacking. The purpose of the present study was to compare the postoperative liver decompensation after MWA and laparoscopic resection (LR) for HCC in patients with CSPH. METHODS The present retrospective study enrolled 222 HCC patients with CSPH who underwent MWA (n = 67) or LR (n = 155). Postoperative liver decompensation, complications, postoperative hospital stays, and overall survival were analyzed. Factors associated with postoperative liver decompensation were identified. RESULTS After propensity score matching, the postoperative liver decompensation rate was significantly lower in the MWA group than that in the LR group (15.5% versus 32.8%, p = 0.030). The multivariable regression analysis identified that type of treatment (MWA vs. LR, odds ratio [OR] 0.44; 95% confidence interval [CI], 0.21-0.91; p = 0.026) and Child-Pugh B (OR, 2.86; 95% CI, 1.24-6.61; p = 0.014) were independent predictors for postoperative liver decompensation. The rate of complications for patients in the MWA group was significantly lower than that in the LR group (p < 0.001). And MWA showed shorter postoperative hospital stays than LR (3 days vs. 6 days, p < 0.001). Overall survival rate between the two groups was not significantly different (p = 0.163). CONCLUSION Compared with laparoscopic resection, microwave ablation has a lower rate of postoperative liver decompensation and might be a better option for HCC patients with CSPH. CLINICAL RELEVANCE STATEMENT Microwave ablation exhibited a lower incidence of postoperative liver decompensation in comparison to laparoscopic resection, thereby conferring greater advantages to hepatocellular carcinoma patients with clinically significant portal hypertension. KEY POINTS •Postoperative liver decompensation rate after microwave ablation was lower than that of laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. •Microwave ablation showed shorter postoperative hospital stays than laparoscopic resection. •Microwave ablation had fewer complications than laparoscopic resection.
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Affiliation(s)
- Hongli Yu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Fenglin Zhao
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Xiaoxiao Men
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Jingrui Yan
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Zongxin Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Qiqi Liu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Le Wang
- Department of Geriatrics, Department of Geriatric Gastroenterology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Min Meng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
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Sheng Y, Zheng J, Tao L, Shen Z, Liang X. Risk factor analysis of conversion in laparoscopic liver resection for intrahepatic cholangiocarcinoma. Surg Endosc 2024; 38:1191-1199. [PMID: 38082010 DOI: 10.1007/s00464-023-10579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/04/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The risk factors of patients with intrahepatic cholangiocarcinoma (ICC) requiring conversion to open surgery have not been adequately studied. This study aimed to determine the risk factors and postoperative outcomes of conversion in patients with ICC. METHODS From May 2014 to September 2022, Unplanned conversions were compared with successful LLRs. RESULTS 153 patients with ICC initially underwent LLR, of which 41 (26.8%) required conversion to open surgery. Multivariate analysis for those factors that were statistically significant or confirmed by clinical studies, tumor proximity to the major vessels (OR 6.643, P < 0.001), and previous upper abdominal surgery (OR 3.140, P = 0.040) were independent predictors of unplanned conversions. Compared to successful LLRs, unplanned conversions showed longer operative times (300.0 vs. 225.0 min, P < 0.001), more blood loss (500.0 vs. 200.0 mL, P < 0.001), higher transfusion rates (46.3% vs. 11.6%, P < 0.001), longer length of stays (13.0 vs. 8.0 days, P < 0.001), and higher rates of major morbidity (39.0% vs. 11.6%, P < 0.001). However, there was no statistically significant difference in 30-day or 90-day mortality between the conversion group and the laparoscopic group. CONCLUSION Conversion during LLR should be anticipated in ICC patients with prior upper abdominal surgery or tumor proximity to major vessels as features.
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Affiliation(s)
- Yubin Sheng
- Department of General Surgery, The First People's Hospital of Jiashan County, No. 1218, South Sports Road, Jiashan, 314100, China
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Junhao Zheng
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Liye Tao
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiao Liang
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Shinkawa H, Kaibori M, Kabata D, Nakai T, Ueno M, Hokuto D, Ikoma H, Iida H, Komeda K, Tanaka S, Kosaka H, Nobori C, Hayami S, Yasuda S, Morimura R, Mori H, Kagota S, Kubo S, Ishizawa T. Laparoscopic and open minor liver resection for hepatocellular carcinoma with clinically significant portal hypertension: a multicenter study using inverse probability weighting approach. Surg Endosc 2024; 38:757-768. [PMID: 38052887 DOI: 10.1007/s00464-023-10591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Liver resection offers substantial advantages over open liver resection (OLR) for patients with hepatocellular carcinoma (HCC) in terms of reduced intraoperative blood loss and morbidity. However, there is limited evidence comparing the indications and perioperative outcomes with the open versus laparoscopic approach for resection. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection (LLR) and OLR for HCC with clinically significant portal hypertension (CSPH). METHODS A total of 316 HCC patients with CSPH (the presence of gastroesophageal varices or platelet count < 100,000/ml and spleen diameter > 12 cm) undergoing minor liver resection at eight centers were included in this study. To adjust for confounding factors between the LLR and OLR groups, an inverse probability weighting method analysis was performed. RESULTS Overall, 193 patients underwent LLR and 123 underwent OLR. After weighting, LLR was associated with a lower volume of intraoperative blood loss and the incidence of postoperative complications (including pulmonary complications, incisional surgical site infection, and paralytic ileus) compared to the OLR group. The 3-, 5-, and 7-year postoperative recurrence-free survival rates were 39%, 26%, and 22% in the LLR group and 49%, 18%, and 18% in the OLR group, respectively (p = 0.18). And, the 3-, 5-, and 7-year postoperative overall survival rates were 71%, 56%, and 44% in the LLR group and 76%, 51%, 44% in the OLR group, respectively (p = 0.87). CONCLUSIONS LLR for HCC patients with CSPH is clinically advantageous by lowering the volume of intraoperative blood loss and incidence of postoperative complications, thereby offering feasible long-term survival.
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Affiliation(s)
- Hiroji Shinkawa
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-0051, Japan.
| | - Masaki Kaibori
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga Prefecture, Japan
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shogo Tanaka
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-0051, Japan
| | - Hisashi Kosaka
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Chihoko Nobori
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Shinya Hayami
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ryo Morimura
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga Prefecture, Japan
| | - Shuji Kagota
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Shoji Kubo
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-0051, Japan
| | - Takeaki Ishizawa
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-0051, Japan
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Xia F, Zhang Q, Ndhlovu E, Zheng J, Yuan M, Gao H, Xia G. Prognosis and safety of laparoscopic hepatectomy for BCLC stage 0/A hepatocellular carcinoma with clinically significant portal hypertension: a multicenter, propensity score-matched study. Surg Endosc 2024; 38:799-812. [PMID: 38062182 DOI: 10.1007/s00464-023-10589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/11/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND AIM The latest Barcelona Clinic Liver Cancer (BCLC) staging system suggests considering surgery in patients with resectable BCLC stage 0/A hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH). This study aimed to evaluate the safety and short- and long-term outcomes of laparoscopic hepatectomy for BCLC stage 0/A HCC patients with CSPH. METHODS We retrospectively reviewed the medical records of 647 HCC patients in BCLC stage 0/A who were treated at five centers between January 2010 and January 2019. Among these patients, 434 underwent laparoscopic hepatectomy, and 213 underwent open hepatectomy. We used Kaplan-Meier analysis to compare the overall survival (OS) rate and recurrence-free survival (RFS) rate between patients with and without CSPH before and after propensity score matching (PSM). Multivariate Cox regression analysis was performed to identify prognostic factors for BCLC stage 0/A patients, and subgroup analyses were also conducted. RESULTS Among the 434 patients who underwent laparoscopic hepatectomy, 186 had CSPH and 248 did not. The Kaplan-Meier analysis showed that the OS and RFS rates were significantly worse in the CSPH group before and after PSM. Multivariate Cox regression analyses identified CSPH as a prognostic factor for poor OS and RFS after laparoscopic hepatectomy. However, CSPH patients treated laparoscopically had a better short- and long-term prognosis than those treated with open surgery. CONCLUSIONS CSPH has a negative impact on the prognosis of BCLC stage 0/A HCC patients after laparoscopic hepatectomy. Laparoscopic hepatectomy is still recommended for treatment, but careful patient selection is essential.
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Affiliation(s)
- Feng Xia
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiao Zhang
- Department of Emergency Medicine, Zhongshan People's Hospital Affiliated to Guangdong Medical University, Zhongshan, Guangdong, China
| | - Elijah Ndhlovu
- Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Zheng
- Department of Science and Education, Shenzhen Baoan District People's Hospital, Guangdong, China
| | - Minggang Yuan
- Department of Thyroid & Breast Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi, Hubei, China
| | - Hengyi Gao
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen Longhua District People's Hospital, Guangdong, China
| | - Guobing Xia
- Department of Hepatobiliary and Pancreatic Surgery, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi, Hubei, China.
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Xiang ZQ, Wu YC, Qu XL, Luo DJ, Liang H, Ameer S, Long ZT, Dai XM, Zhu Z. Laparoscopic hepatectomy for hepatocellular carcinoma in patients with clinically significant portal hypertension: a systematic review and meta-analysis. World J Surg Oncol 2024; 22:3. [PMID: 38166925 PMCID: PMC10763288 DOI: 10.1186/s12957-023-03264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To compare the effects of laparoscopic hepatectomy (LH) on the short-term and long-term outcomes in hepatocellular carcinoma (HCC) patients with and without clinically significant portal hypertension (CSPH). METHODS A systematic literature search of the PubMed, EMBASE, and Cochrane databases was performed for articles published from inception to March 1, 2023. Meta-analysis of surgical and oncological outcomes was performed using a random effects model. Data were summarized as mean difference and risk ratio with 95% confidence intervals. RESULTS Five cohort studies with a total of 310 HCC patients were included (CSPH 143; Non-CSPH 167). In terms of surgical outcomes, estimated blood loss and the length of hospital stay were significantly lower in the Non-CSPH group than in the CSPH group. There were no significant differences between the two groups regarding other surgical outcomes, including the operative time, ratio of conversion to open surgery, and overall complication rate. In addition, there were also no significant differences between the two groups regarding the oncological outcomes, such as 1-, 3-, and 5-year overall survival. CONCLUSIONS HCC patients with and without CSPH who underwent LH had comparable surgical and oncological outcomes. LH is a safe and effective treatment for HCC patients with CSPH under the premise of rational screening of patients.
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Affiliation(s)
- Zhi-Qiang Xiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Ya-Chen Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xi-Lin Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Dan-Jie Luo
- Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Hao Liang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Sajid Ameer
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Zhang-Tao Long
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Xiao-Ming Dai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
| | - Zhu Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
- Department of Education and Training, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
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Aliseda D, Zozaya G, Martí-Cruchaga P, Lujan J, Almeida A, Blanco N, Sabatella L, Sangro B, Rotellar F. Minimally invasive liver surgery for hepatocellular carcinoma in patients with portal hypertension. BJS Open 2023; 7:7146620. [PMID: 37115654 PMCID: PMC10146929 DOI: 10.1093/bjsopen/zrad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/20/2023] [Accepted: 02/26/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Daniel Aliseda
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Gabriel Zozaya
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Pablo Martí-Cruchaga
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
| | - Juan Lujan
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Ana Almeida
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Nuria Blanco
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Lucas Sabatella
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Bruno Sangro
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
- Liver Unit and Hepato-Pancreato-Biliary Oncology Area, Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Fernando Rotellar
- Department of General Surgery, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
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8
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Challenging Scenarios and Debated Indications for Laparoscopic Liver Resections for Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15051493. [PMID: 36900284 PMCID: PMC10001345 DOI: 10.3390/cancers15051493] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Laparoscopic liver resections (LLRs) have been increasingly adopted for the treatment of hepatocellular carcinoma (HCC), with safe short- and long-term outcomes reported worldwide. Despite this, lesions in the posterosuperior segments, large and recurrent tumors, portal hypertension, and advanced cirrhosis currently represent challenging scenarios in which the safety and efficacy of the laparoscopic approach are still controversial. In this systematic review, we pooled the available evidence on the short-term outcomes of LLRs for HCC in challenging clinical scenarios. All randomized and non-randomized studies reporting LLRs for HCC in the above-mentioned settings were included. The literature search was run in the Scopus, WoS, and Pubmed databases. Case reports, reviews, meta-analyses, studies including fewer than 10 patients, non-English language studies, and studies analyzing histology other than HCC were excluded. From 566 articles, 36 studies dated between 2006 and 2022 fulfilled the selection criteria and were included in the analysis. A total of 1859 patients were included, of whom 156 had advanced cirrhosis, 194 had portal hypertension, 436 had large HCCs, 477 had lesions located in the posterosuperior segments, and 596 had recurrent HCCs. Overall, the conversion rate ranged between 4.6% and 15.5%. Mortality and morbidity ranged between 0.0% and 5.1%, and 18.6% and 34.6%, respectively. Full results according to subgroups are described in the study. Advanced cirrhosis and portal hypertension, large and recurrent tumors, and lesions located in the posterosuperior segments are challenging clinical scenarios that should be carefully approached by laparoscopy. Safe short-term outcomes can be achieved provided experienced surgeons and high-volume centers.
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Fujisaki H, Fukami Y, Arikawa T, Saito T, Osawa T, Komatsu S, Kaneko K, Kurokawa T, Nonami T, Sano T. Long-term results of laparoscopic Hassab's procedure for esophagogastric varices with portal hypertension. Asian J Endosc Surg 2022; 15:505-512. [PMID: 35132809 DOI: 10.1111/ases.13038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recent reports have shown laparoscopic gastric devascularization and splenectomy (Hassab's procedure) to be a safe and effective treatment for esophagogastric varices with portal hypertension. However, the long-term postoperative results remain unclear. METHODS Between 2009 and 2015, 17 patients with portal hypertension and esophagogastric varices underwent laparoscopic Hassab's procedure at our institution. Two patients were lost to long-term follow-up (at least 2 years) and excluded. The remaining 15 patients' data and endoscopic findings were retrospectively reviewed. RESULTS The median postoperative follow-up period was 56 months. The median spleen volume, operation time, blood loss, and length of postoperative hospital stay were 651 (320-1,265) mL, 305 (275-547) minutes, 347 (24-1,131) mL, and 20 (8-41) days, respectively. According to the endoscopic findings 1 year after surgery, the esophagogastric varices disappeared in three patients and improved in 12 patients. The median platelet count was significantly higher 1 year after surgery (19.7 × 104 /dL) than before surgery (5.5 × 104 /dL) (P < .001) and remained stable 2 years after surgery. Two patients died of liver disease. The remaining 13 patients, with a median postoperative follow-up of 57 months, were alive without bleeding from esophagogastric varices. CONCLUSION Laparoscopic Hassab's procedure is a feasible treatment for esophagogastric varices with portal hypertension in terms of both short- and long-term results.
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Affiliation(s)
- Hiroyuki Fujisaki
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Yasuyuki Fukami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takashi Arikawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takaaki Osawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Tsuyoshi Kurokawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Toshiaki Nonami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
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Guo ZY, Hong Y, Tu B, Cheng Y, Wang XM. Laparoscopic liver resection for hepatocellular carcinoma complicated with significant portal hypertension: A propensity score-matched survival analysis. Hepatobiliary Pancreat Dis Int 2022:S1499-3872(22)00050-9. [PMID: 35370090 DOI: 10.1016/j.hbpd.2022.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Significant portal hypertension (SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma (HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. METHODS HCC patients with cirrhosis who underwent laparoscopic liver resection (LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching (PSM) analysis was performed to minimize bias. RESULTS A total of 165 patients were divided into two groups based on the presence (SPH, n = 76) or absence (non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group (P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate (n = 0), overall postoperative complications (47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification (P = 0.347), conversion to open surgery (9.2% vs. 6.7%, P = 0.557), or length of hospitalization (16 vs. 15 days, P = 0.203) between SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM (log-rank P > 0.05).After PSM, alpha-fetoprotein (AFP) ≥ 400 μg/L [hazard ratio (HR) = 4.71, 95% confidence interval (CI): 2.69-8.25], ascites (HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists (ASA) classification (III vs. II) (HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm (HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. CONCLUSIONS LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.
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Affiliation(s)
- Zhang-You Guo
- Department of Minimally Invasive Interventional Therapy, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming 650118, China
| | - Yuan Hong
- Medical Laboratory, The First Affiliated Hospital of Kunming Medical University, Institute of Experimental Diagnostics of Yunnan Province, Key Laboratory of Laboratory Medicine of Yunnan Province, Kunming 650032, China
| | - Bing Tu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Xiao-Mei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China.
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11
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Shen ZF, Liang X. Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension. World J Clin Cases 2021; 9:2419-2432. [PMID: 33889608 PMCID: PMC8040172 DOI: 10.12998/wjcc.v9.i11.2419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic advantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients’ preoperative liver function should be adequately estimated.
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Affiliation(s)
- Ze-Feng Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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