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.
Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study / R.I. Troisi, G. Berardi, Z. Morise, F. Cipriani, S. Ariizumi, C. Sposito, V. Panetta, I. Simonelli, S. Kim, B.K.P. Goh, S. Kubo, S. Tanaka, Y. Takeda, G.M. Ettorre, N. Russolillo, G.C. Wilson, M. Cimino, R. Montalti, M.C. Giglio, K. Igarashi, C. Chan, G. Torzilli, T.T. Cheung, V. Mazzaferro, H. Kaneko, A. Ferrero, D.A. Geller, H. Han, A. Kanazawa, G. Wakabayashi, L. Aldrighetti, M. Yamamoto. - In: BRITISH JOURNAL OF SURGERY. - ISSN 0007-1323. - 108:2(2021 Mar), pp. 196-204.
|Titolo:||Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study|
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||mar-2021|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/bjs/znaa041|
|Appare nelle tipologie:||01 - Articolo su periodico|