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Benefits of laparoscopic liver resection in patients with hepatocellular carcinoma and portal hypertension: a case-matched study

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Abstract

Background

The advantages of laparoscopy over open liver resection in patients with cirrhosis have been widely demonstrated. On the other hand, information on the role of minimally invasive liver surgery in the presence of clinically significant portal hypertension (CSPH) is scarce. The aim of this study was to evaluate the role of laparoscopic liver resection in selected cirrhotic patients with CSPH.

Methods

A retrospective case–control study of cirrhotic patients with hepatocellular carcinoma who were treated with laparoscopic liver resection was conducted from December 2005 to April 2016. A total of 45 patients were included. Patients were divided into two groups according to the presence or absence of clinically significant portal hypertension. Fifteen cirrhotic patients with CSPH were matched with 30 patients without CSPH.

Results

Overall, there were no differences in intraoperative results. No conversion to open surgery occurred in the CSPH group, and 3 patients were converted in the Non-CSPH group (0 vs. 10% p = 0.57). Only 2 (7%) patients in the Non-CSPH group and 1 (7%) in the CSPH group had relevant complications (modified Clavien–Dindo classification III). Two patients in the Non-CSPH group and one in the CSPH group developed transient ascites (7 vs. 7%). Postoperative hospital stay was similar in both groups, with a median of 4 days in the CSPH group and 3 days in the Non-CSPH group (p = 0.37). The median follow-up of the entire cohort was 38 months (range 7–100). Overall survival rates at 1 and 3 years were 100 and 87%, respectively. There was no significant difference between the groups in terms of survival (p = 0.8).

Conclusion

This initial study showed that laparoscopic resection in patients with CSPH can be performed safely in well-selected patients and expand the current surgical indications in patients with CSPH. Prospective trials with a larger sample size are necessary to confirm these results.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. doi:10.1002/ijc.29210

    PubMed Central  Google Scholar 

  2. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255. doi:10.1016/S0140-6736(11)61347-0

    Article  PubMed  Google Scholar 

  3. Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30:1434–1440. doi:10.1002/hep.510300629

    Article  CAS  PubMed  Google Scholar 

  4. Bruix J, Reig M, Sherman M (2016) Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology 150:836–853. doi:10.1053/j.gastro.2015.12.041

    Article  Google Scholar 

  5. Cha CH, Ruo L, Fong Y, Jarnagin WR, Shia J, Blumgart LH, DeMatteo RP (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238:315-21-3. doi:10.1097/01.sla.0000086548.84705.ef

    Google Scholar 

  6. Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan J, Visa J, Bru C, Rodes J (1996) Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 111:1018–1022. doi:10.1016/S0016-5085(96)70070-7

    Article  CAS  PubMed  Google Scholar 

  7. Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362:1907–1917. doi:10.1016/S0140-6736(03)14964-1

    Article  PubMed  Google Scholar 

  8. Ferrer-Fàbrega J, Forner A, Liccioni A, Miquel R, Molina V, Navasa M, Fondevila C, García-Valdecasas JC, Bruix J, Fuster J (2016) Prospective validation of ab initio liver transplantation in hepatocellular carcinoma upon detection of risk factors for recurrence after resection. Hepatology 63:839–849. doi:10.1002/hep.28339

    Article  PubMed  Google Scholar 

  9. Llovet JM, Fuster J, Bruix J (2004) The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl 10:S115–S120. doi:10.1002/lt.20034

    Article  PubMed  Google Scholar 

  10. Gagner M, Rheault M DJ (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:97–98

    Google Scholar 

  11. Xiong J-J, Altaf K, Javed M a, Huang W, Mukherjee R, Mai G, Sutton R, Liu X-B, Hu W-M (2012) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. World J Gastroenterol 18:6657–6668. doi:10.3748/wjg.v18.i45.6657

    Article  PubMed  PubMed Central  Google Scholar 

  12. Truant S, Bouras a F, Hebbar M, Boleslawski E, Fromont G, Dharancy S, Leteurtre E, Zerbib P, Pruvot FR (2011) Laparoscopic resection vs. open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: a case-matched study. Surg Endosc 25:3668–3677. doi:10.1007/s00464-011-1775-1

    Article  CAS  PubMed  Google Scholar 

  13. Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, Karoui M, Duvoux C, Dhumeaux D, Fagniez P-L (2006) Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives. Ann Surg 243:499–506. doi:10.1097/01.sla.0000206017.29651.99

    Article  PubMed  PubMed Central  Google Scholar 

  14. Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048. doi:10.1002/bjs.6680

    Article  CAS  PubMed  Google Scholar 

  15. Morise Z, Ciria R, Cherqui D, Chen K-H, Belli G, Wakabayashi G (2015) Can we expand the indications for laparoscopic liver resection? A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease. J Hepatobiliary Pancreat Sci. doi:10.1002/jhbp.215

    PubMed  Google Scholar 

  16. Buell JF, Cherqui D, Geller D a., O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker C-G, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey J-N, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery. Ann Surg 250:825–830. doi:10.1097/SLA.0b013e3181b3b2d8

    Article  PubMed  Google Scholar 

  17. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943. doi:10.1016/j.jhep.2011.12.001

    Article  Google Scholar 

  18. Bruix J, Sherman M (2011) Management of hepatocellular carcinoma: an update. Hepatology 53:1020–1022. doi:10.1002/hep.24199

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC (2009) The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 6:573–582. doi:10.1038/nrgastro.2009.149

    Article  CAS  PubMed  Google Scholar 

  20. Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355. doi:10.1007/s00534-005-0999-7

    Article  PubMed  Google Scholar 

  21. Sala M, Fuster J, Llovet JM, Navasa M, Solé M, Varela M, Pons F, Rimola A, García-Valdecasas JC, Brú C, Bruix J (2004) High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation. Liver Transplant 10:1294–1300. doi:10.1002/lt.20202

    Article  Google Scholar 

  22. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50–50 criteria” on postoperative day 5. Ann Surg 242:824–829. doi:10.1097/01.sla.0000189131.90876.9e

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gaillard M, Tranchart H, Dagher I (2014) Laparoscopic liver resections for hepatocellular carcinoma: current role and limitations. World J Gastroenterol 20:4892–4899. doi:10.3748/wjg.v20.i17.4892

    Article  PubMed  PubMed Central  Google Scholar 

  25. Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, Sugawara Y, Minagawa M, Takayama T, Kawasaki S, Makuuchi M (2003) Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol 38:200–207

    Article  PubMed  Google Scholar 

  26. Fuks D, Dokmak S, Paradis V, Diouf M, Durand F, Belghiti J (2012) Benefit of initial resection of hepatocellular carcinoma followed by transplantation in case of recurrence: an intention-to-treat analysis. Hepatology 55:132–140. doi:10.1002/hep.24680

    Article  PubMed  Google Scholar 

  27. Forner A, Reig M, Varela M, Burrel M, Feliu J, Briceño J, Sastre J, Martí-Bonmati L, Llovet JM, Bilbao JI, Sangro B, Pardo F, Ayuso C, Bru C, Tabernero J, Bruix J (2016) Diagnosis and treatment of hepatocellular carcinoma. Update consensus document from the AEEH, SEOM, SERAM, SERVEI and SETH. Med Clin (Barc) 146:511.e1–511.e22. doi:10.1016/j.medcli.2016.01.028

    Article  Google Scholar 

  28. Hasegawa K, Kokudo N, Makuuchi M, Izumi N, Ichida T, Kudo M, Ku Y, Sakamoto M, Nakashima O, Matsui O, Matsuyama Y (2013) Comparison of resection and ablation for hepatocellular carcinoma: a cohort study based on a Japanese nationwide survey. J Hepatol 58:724–729. doi:10.1016/j.jhep.2012.11.009

    Article  PubMed  Google Scholar 

  29. Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Sato T, Masuzaki R, Kondo Y, Goto T, Yoshida H, Omata M, Koike K (2012) Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 107:569–577. doi:10.1038/ajg.2011.425 (quiz 578)

    Article  CAS  PubMed  Google Scholar 

  30. Berzigotti A, Reig M, Abraldes JG, Bosch J, Bruix J (2015) Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review and meta-analysis. Hepatology 61:526–536. doi:10.1002/hep.27431

    Article  PubMed  Google Scholar 

  31. Choi SB, Kim HJ, Song TJ, Ahn HS, Choi SY (2014) Influence of clinically significant portal hypertension on surgical outcomes and survival following hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci 21:639–647. doi:10.1002/jhbp.124

    Article  PubMed  Google Scholar 

  32. Tang Y-H, Zhu W-J, Wen T-F (2014) Influence of clinically significant portal hypertension on hepatectomy for hepatocellular carcinoma: a meta-analysis. Asian Pac J Cancer Prev 15:1649–1654

    Article  PubMed  Google Scholar 

  33. Lee SS, Hadengue A, Girod C, Braillon A, Lebrec D (1987) Reduction of intrahepatic vascular space in the pathogenesis of portal hypertension. In vitro and in vivo studies in the rat. Gastroenterology 93:157–161

    Article  CAS  PubMed  Google Scholar 

  34. Soubrane O, Goumard C, Laurent A, Tranchart H, Truant S, Gayet B, Salloum C, Luc G, Dokmak S, Piardi T, Cherqui D, Dagher I, Boleslawski E, Vibert E, Sa Cunha A, Belghiti J, Pessaux P, Boelle P-Y, Scatton O (2014) Laparoscopic resection of hepatocellular carcinoma: a French survey in 351 patients. HPB (Oxford) 16:357–365. doi:10.1111/hpb.12142

    Article  Google Scholar 

  35. Tranchart H, Di Giuro G, Lainas P, Pourcher G, Devaquet N, Perlemuter G, Franco D, Dagher I (2013) Laparoscopic liver resection with selective prior vascular control. Am J Surg 205:8–14. doi:10.1016/j.amjsurg.2012.04.015

    Article  PubMed  Google Scholar 

  36. Aldrighetti L, Guzzetti E, Pulitanò C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86. doi:10.1002/jso.21541

    Article  PubMed  Google Scholar 

  37. Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L (2013) Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 100:535–542. doi:10.1002/bjs.9025

    Article  PubMed  Google Scholar 

  38. Dagher I, Belli G, Fantini C, Laurent A, Tayar C, Lainas P, Tranchart H, Franco D, Cherqui D (2010) Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience. J Am Coll Surg 211:16–23. doi:10.1016/j.jamcollsurg.2010.03.012

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Hospital Clinic Barcelona, University of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain

    Víctor Molina, Jaime Sampson-Dávila, Joana Ferrer, Constantino Fondevila, Rafael Díaz del Gobbo, David Calatayud, Juan Carlos García-Valdecasas & Josep Fuster

  2. Liver Unit, Barcelona Clinic Liver Cancer Group, Hospital Clinic, Barcelona, Spain

    Jordi Bruix & Josep Fuster

  3. IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain

    Jordi Bruix & Josep Fuster

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  1. Víctor Molina
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Correspondence to Josep Fuster.

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Dr. Víctor Molina reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Jaime Sampson reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Joana Ferrer-Fábrega reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Constantino Fondevila reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Rafael Díaz del Gobbo reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. David Calatayud reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Jordi Bruix reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Juan Carlos García-Valdecasas reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. Dr. Josep Fuster reports no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Molina, V., Sampson-Dávila, J., Ferrer, J. et al. Benefits of laparoscopic liver resection in patients with hepatocellular carcinoma and portal hypertension: a case-matched study. Surg Endosc 32, 2345–2354 (2018). https://doi.org/10.1007/s00464-017-5930-1

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