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Background: To compare the outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC) with two methods. Methods: We retrospectively reviewed a data of 177 patients who underwent major liver resection for HCC (LLR; n = 67 vs. OLR; n = 110). We performed 1:1 propensity score matching (PSM) between two groups and matched 65 patients for both groups. Another comparison was done with already published article as a benchmark after applying similar inclusion and exclusion criteria (LLR; n = 30 vs. OLR; n = 34). Results: After PSM, there were no significant differences in blood loss (1,407.2 ± 2,322.7 vs. 1,071.5 ± 1,160.6 mL; p = 0.299), and transfusion rate (32.2% vs. 32.0%; p = 0.574) between two groups. The mean operative time was significantly longer in LLR than in the OLR group (418.7 ± 172 vs. 335.1 ± 121.6 min; p = 0.002). Complication rate (21.5% vs. 33.8%; p = 0.085) was similar and the mean hospital stay was shorter in the LLR than in the OLR group (11.4 ± 8.5 vs. 17.6 ± 21.4 days; p = 0.009). After benchmarking method, there were no significant differences in between two groups in terms of blood loss (780 ± 822 vs. 947 ± 660.5 mL; p = 0.382), transfusion rate (30.0 vs. 32.4%; p = 0.528), hospital stay (9 ± 3.7 vs. 10.4 ± 3.59 days; p = 0.119), and complication rate (10.0% vs. 20.6%; p = 0.208). Operation time (395 ± 166.6 vs. 296 ± 68.3 min; p = 0.002) was significantly longer in the LLR than in the OLR group. Benchmarking method showed significant loss of number of patients analysed, but results were quite similar to PSM method. Conclusions: Both methods showed that major LLR was safe compared to major OLR. Benchmarking method can be easily used to compare with data of other published article.

Background: Although various pathologic grading systems evaluating tumor response to neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) exist, their prognostic value to predict recurrence after surgery has not been validated in. This study aimed to show that microscopic tumor mapping in post-NAT specimens could predict postoperative oncologic outcomes. Methods: Among patients who underwent pancreaticoduodenectomy after NAT for PDAC between 2019 and 2021, 44 pathological responders with College of American Pathologists (CAP) scores 1 or 2 were prospectively enrolled. Microscopic mapping was performed to identify residual tumor loci within the macroscopic tumor bed using 4 mm 2 -sized pixels. Patients were divided into large extent (LE, n = 22) and small extent (SE, n = 22) groups with a cutoff value of 300 mm 2 . Survival outcomes were compared between the two groups, and the diagnostic performance of microscopic tumor mapping was evaluated with receiver operating (ROC) curves. Results: Recurrence and cancer-related mortality rates were significantly higher in the LE group (18.2% vs. 50.0%, p = 0.026; 0 vs. 18.2%, p = 0.001). 1-year and 3-year disease-free survival rates were significantly lower in the LE group compared to the SE group (95.5% vs. 54.5% and 80.4% vs. 50.0%, respectively; p = 0.010). When ROC curves were compared, the area under curve (AUC) was 0.759 for pathologic response measured by microscopic tumor mapping, which was higher compared to the CAP score (AUC 0.586). Conclusions: Evaluation of residual tumor in post-NAT specimens by microscopic tumor mapping is a significant predictor for early recurrence after surgery, with better performance in predicting recurrence compared to the CAP score.

Background: Radiofrequency ablation (RFA) is a widely used percutaneous local ablation technique for the treatment of hepatocellular carcinoma (HCC). Yet the optimal treatment for marginal recurrence after RFA is not established, and the role of salvage hepatectomy is still unclear. Methods: A retrospective analysis was performed on 60 patients who underwent salvage hepatectomy (SH) for recurrent HCC after RFA between January 2004 and August 2022 at a single tertiary referral center. Short-term and long-term outcomes were compared to a matched control group (n = 60) of patients who underwent primary hepatectomy (PH) as initial treatment during the same period. Results: The two groups showed no statistically significant difference in operative extent, operation time, and intraoperative blood loss. Postoperative morbidity rates were similar, and there was no postoperative mortality in either group. After intention-to-treat analysis, recurrence rates were significantly higher in the SH group for both local recurrence (36 [60.0%] vs. 14 [23.3%], p < 0.001) and systemic recurrence (22 [36.7%] vs. 3 [5.0%], p < 0.001). The 1-, 3-, and 5-year DFS rates were significantly worse in the SH group compared to the PH group (83.1% vs. 94.5%, 46.9% vs. 70.4%, and 26.2% vs. 66.9%, respectively; p < 0.001). Cancer-related death showed higher incidence in the SH group (13 [21.7%] vs. 4 [6.7%], p = 0.018). However, the difference in 1-, 3-, and 5-year overall survival rates between the two groups was not statistically significant (93.0% vs. 98.1%, 81.9% vs. 95.8%, and 78.0% vs. 92.2%, respectively; p = 0.091). Conclusions: Salvage hepatectomy is an acceptable treatment option for recurrence after RFA with short-term outcomes comparable to primary resection. However, treatment should be planned carefully, because recurrent HCC after RFA exhibits more aggressive behavior.

Background: Unplanned conversion (UPC) to open surgery is considered to be a predictor of poor postoperative outcomes. However, the effects of UPC on the survival of patients with hepatocellular carcinoma (HCC) remain controversial. Therefore, in this study, we compared the surgical and oncological outcomes between patients who underwent LLR and those who underwent UPC during LLR for hepatocellular carcinoma (HCC) located in posterosuperior (PS) segments. Patients were matched by propensity score matching (PSM). Methods: Among 1,029 patients with HCC who underwent hepatectomy between 2004 and 2021, 251 were eligible for the study. UPC was defined as resection attempted by LLR, which required conversion to unscheduled open surgery owing to bleeding. Results: Of 251 patients who underwent liver resection for HCC in PS segments, 29 (26.0%) required UPC and 222 underwent LLR. After 1 : 5 PSM, 25 patients were selected for the UPC group and 120 for the LLR group. Blood loss, intraoperative transfusion rate, hospital stay, and postoperative complication rates were greater in the UPC group. Regarding oncologic outcomes, although the 5-year overall survival rate was similar in both groups (p = 0.544), the recurrence-free survival rate was lower in the UPC group (p < 0.001). Multivariable analysis showed that only hypoalbuminemia was significantly associated with increased likelihood of UPC (hazard ratio 4.873; 95% confidence interval 1.904-12.474; p = 0.001). Conclusions: UPC was associated with poor short-term outcomes as well as inferior long-term outcomes compared with LLR for HCC in PS segments. Therefore, surgeons must carefully select patients and consider early conversion if unexpected bleeding occurs to maintain safety and oncologic outcomes.