Objective: To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS).Background: Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist.Material and Methods: A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated.Results: A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9 +/- 3.1 vs MILR 226 +/- 4.0, P=0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P=0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P=0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P=0.015), posthepatectomy liver failure (0.6% vs 4.3%, P=0.008), and bile leaks (2.2% vs 6.4%, P=0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P=0.002) and day 3 (3.1% vs 11.4%, P<0.001); hospital stay was significantly shorter (5.8 +/- 1.9 vs 7.5 +/- 1.7, P<0.001). There was no significant difference in overall survival and disease-free survival.Conclusions: MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.
Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome / Berardi, Giammauro; Ivanics, Tommy; Sapisochin, Gonzalo; Ratti, Francesca; Sposito, Carlo; Nebbia, Martina; D'Souza, Daniel M; Pascual, Franco; Tohme, Samer; D'Amico, Francesco Enrico; Alessandris, Remo; Panetta, Valentina; Simonelli, Ilaria; Del Basso, Celeste; Russolillo, Nadia; Fiorentini, Guido; Serenari, Matteo; Rotellar, Fernando; Zimitti, Giuseppe; Famularo, Simone; Hoffman, Daniel; Onkendi, Edwin; Lopez-Ben, Santiago; Caula, Celia; Rompianesi, Gianluca; Chopra, Asmita; Abu Hilal, Mohammed; Torzilli, Guido; Corvera, Carlos; Alseidi, Adnan; Helton, Scott; Troisi, Roberto I; Simo, Kerri; Conrad, Claudius; Cescon, Matteo; Cleary, Sean; Kwon, Choon H D; Ferrero, Alessandro; Ettorre, Giuseppe M; Cillo, Umberto; Geller, David; Cherqui, Daniel; Serrano, Pablo E; Ferrone, Cristina; Mazzaferro, Vincenzo; Aldrighetti, Luca; Kingham, T Peter. - In: ANNALS OF SURGERY. - ISSN 0003-4932. - ELETTRONICO. - 278:5(2023), pp. e1041-e1047. [10.1097/SLA.0000000000005861]
Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome
Serenari, Matteo;Cescon, Matteo;
2023
Abstract
Objective: To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS).Background: Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist.Material and Methods: A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated.Results: A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9 +/- 3.1 vs MILR 226 +/- 4.0, P=0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P=0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P=0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P=0.015), posthepatectomy liver failure (0.6% vs 4.3%, P=0.008), and bile leaks (2.2% vs 6.4%, P=0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P=0.002) and day 3 (3.1% vs 11.4%, P<0.001); hospital stay was significantly shorter (5.8 +/- 1.9 vs 7.5 +/- 1.7, P<0.001). There was no significant difference in overall survival and disease-free survival.Conclusions: MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
