Benefits of laparoscopic liver resection in patients with hepatocellular carcinoma and portal hypertension: a case-matched study
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.
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.
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).
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.
KeywordsPortal hypertension Liver transplant Hepatocellular carcinoma Laparoscopy Liver resection Survival
Compliance with ethical standards
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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