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Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre
R I Troisi1,2, G Berardi1,2,3, Z Morise4
1Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Insights
Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh B cirrhosis shows reduced blood loss and complications compared to open surgery. Patients without portal hypertension and with Child-Pugh B7 scores may benefit most from this approach.
Area of Science:
- Hepatobiliary surgery
- Minimally invasive surgical techniques
- Hepatocellular carcinoma (HCC) management
Background:
- Laparoscopic liver resection is established for Child-Pugh A cirrhosis.
- Its efficacy in Child-Pugh B cirrhosis remains unclear.
- This study compares open versus laparoscopic resection for HCC in Child-Pugh B patients.
Purpose of the Study:
- To compare the outcomes of open and laparoscopic liver resection for hepatocellular carcinoma (HCC) in patients with Child-Pugh B cirrhosis.
- To identify patient subgroups that may benefit more from laparoscopic approaches.
Main Methods:
- Retrospective cohort study involving 17 centers.
- 100 laparoscopic and 100 open liver resections were matched using propensity score analysis.
- 17 predefined variables were used for matching.
Main Results:
- 90-day mortality was similar between groups (4.0% open vs. 2.0% laparoscopic).
- Laparoscopic resection demonstrated significantly lower blood loss (110ml vs. 400ml), less morbidity (38.0% vs. 51.0%), and fewer major complications (7.0% vs. 21.0%).
- Patients without portal hypertension and with Child-Pugh B7 scores showed better outcomes with laparoscopy.
Conclusions:
- Laparoscopic liver resection is associated with improved short-term outcomes in Child-Pugh B cirrhosis.
- Patients without preoperative portal hypertension and with Child-Pugh B7 cirrhosis are potential candidates for laparoscopic liver surgery.
- Further research may refine patient selection for minimally invasive liver resection in advanced cirrhosis.
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.
