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

Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Fondevila, Constantino; Gobbo, Rafael; Calatayud, David G.; Bruix, Jordi; García‐Valdecasas, Juan Carlos; Fuster, Josep

doi:10.1007/s00464-017-5930-1

Cited by 37 publications

(31 citation statements)

References 38 publications

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“…Furthermore, it has recently been shown that patients with clinically significant portal hypertension (CSPH) may benefit from a minimally invasive approach instead of an open one. In detail, a study from Spain comparing 30 patients with HCC and no-CSPH versus 15 patients with HCC and CSPH, demonstrated that the two groups have the same incidence of peri-operative morbidity, and no differences in terms of disease-free and overall survival [41]. Those data were later confirmed from another study including patients undergone minor and major laparoscopic and robotic liver resections and comparing CSPH versus no-CSPH ([18and27], respectively) [42].…”

Section: Minimally Invasive Surgery For Liver Resectionsmentioning

confidence: 87%

Liver resection in Cirrhotic liver: Are there any limits?

Chan¹,

Kow

Hibi

et al. 2020

International Journal of Surgery

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Liver resection remains one of the most technically challenging surgical procedure in abdominal surgery due to the complex anatomical arrangement in the liver and its rich blood supply that constitutes about 20% of the cardiac output per cycle. The challenge for resection in cirrhotic livers is even higher because of the impact of surgical stress and trauma imposed on borderline liver function and the impaired ability for liver regeneration in cirrhotic livers. Nonetheless, evolution and advancement in surgical techniques as well as knowledge in perioperative management of liver resection has led to a substantial improvement in surgical outcome in recent decade. The objective of this article was to provide updated information on the recent developments in liver surgery, from preoperative evaluation, to technicality of resection, future liver remnant augmentation and finally, postoperative management of complications.❖ < 10% at 15min for trisectionectomy or bisectorectomy of liver ❖ 10-19% for hemihepatectomy, right sided sectorectomy ❖ 20-29% for segmentectomy ❖ 30-39% for limited resection (eg wedge resection) ❖ > 40% for enucleation

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Section: Minimally Invasive Surgery For Liver Resectionsmentioning

confidence: 87%

Liver resection in Cirrhotic liver: Are there any limits?

Chan¹,

Kow

Hibi

et al. 2020

International Journal of Surgery

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“…The hepatic ligament was then removed and labelled on the surface of the liver 2 cm adjacent to the tumour. Finally, we completely resected the entire hepatic segment or lobe[ 15 ]. For PRFA we used computed tomography (CT) or magnetic resonance imaging (MRI) for ultrasonography guidance in real-time.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous radiofrequency ablation is superior to hepatic resection in patients with small hepatocellular carcinoma

Zhang

Sun

et al. 2020

WJCC

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BACKGROUND It is not known whether percutaneous radiofrequency ablation (PRFA) has the same treatment efficacy and fewer complications than laparoscopic resection in patients with small centrally located hepatocellular carcinoma (HCC). AIM To compare the effectiveness of PRFA with classical laparoscopic resection in patients with small HCC and document the safety parameters. METHODS In this retrospective study, 85 patients treated with hepatic resection (HR) and 90 PRFA-treated patients were enrolled in our hospital from July 2016 to July 2019. Treatment outcomes, including major complications and survival data, were evaluated. RESULTS The results showed that minor differences existed in the baseline characteristics between the patients in the two groups. PRFA significantly increased cumulative recurrence-free survival (hazard ratio 1.048, 95%CI: 0.265–3.268) and overall survival (hazard ratio 0.126, 95%CI: 0.025–0.973); PRFA had a lower rate of major complications than HR (7.78% vs 20.0%, P < 0.05), and hospital stay was shorter in the PRFA group than in the HR group (7.8 ± 0.2 d vs 9.5 ± 0.3 d, P < 0.001). CONCLUSION Based on the data obtained, we conclude that PRFA was superior to HR and may reduce complications and hospital stay in patients with small HCC.

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“…48,49 In selected peripherally located cases, in which a percutaneous approach is suboptimal, surgical resection emerges as a safe and effective treatment strategy even in the presence of CSPH. 47,50,51 Another unresolved question is the potential superiority of surgical resection over locoregional therapies, particularly transarterial chemoembolization (TACE), in patients with multifocal disease. Several retrospective analyses have shown survival benefit of resection compared to TACE in intermediate patients, but these studies suffered from unintentional selection bias because those patients who are selected for hepatic resection rather than TACE have features that gave the surgeon confidence that a good outcome would be achieved, whereas those selected for TACE probably lacked such characteristics, immediately introducing a bias against TACE.…”

Section: Surgical Resection: Where Are the Limits?mentioning

confidence: 99%

Controversies in the management of hepatocellular carcinoma

et al. 2019

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The management of hepatocellular carcinoma (HCC) has evolved considerably over the last decade. Surveillance of cirrhotic patients and refinements to imaging techniques have enabled a relevant proportion of patients to be diagnosed at an early stage, when effective therapies are feasible. Resection, transplantation and ablation are all options in patients with early stage HCC. Thus, there is some controversy regarding which is the best treatment approach in challenging scenarios. There have also been major developments in locoregional therapies, particularly in intraarterial approaches. Finally, the systemic treatment for HCC has changed dramatically following the demonstration of a survival benefit with sorafenib; there are currently several firstline (sorafenib and lenvatinib) and second-line (regorafenib, cabozantinib and ramucirumab) treatments that have shown a survival benefit. Expectations for immune checkpoint inhibitors are high, with the results of the ongoing phase III trials eagerly awaited. In this review we discuss some of the controversies in the management of HCC, focussing in particular on systemic therapy.

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

Abstract: 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.

Cited by 37 publications

References 38 publications

Liver resection in Cirrhotic liver: Are there any limits?

Liver resection in Cirrhotic liver: Are there any limits?

Percutaneous radiofrequency ablation is superior to hepatic resection in patients with small hepatocellular carcinoma

Controversies in the management of hepatocellular carcinoma

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