Comparison of clinical outcomes of laparoscopic versus open surgery for recurrent hepatocellular carcinoma: a meta-analysis

Cai, Wenwu; Liu, Zhide; Xiao, Yangyan; Zhang, Weichang; Tang, Dehua; Cheng, Boran; Li, Qinglong

doi:10.1007/s00464-019-06996-4

Cited by 22 publications

(16 citation statements)

References 35 publications

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“…To the best of our knowledge, no randomized controlled trials (RCTs) and even limited retrospective studies have been performed to compare the outcomes between LRH and open repeat hepatectomy (ORH). Although a few systematic reviews have been conducted to assess safety and efficiency of LRH for recurrent liver tumors, some high-quality multicenter studies have been published recently and not included in these reviews (7,8). Herein, the purpose of this study was to carry out a propensity score-based study and a metaanalysis to compare the postoperative outcomes of patients who underwent LRH with those of patients receiving ORH and produce recommendations on the safe and effective practice for recurrent liver tumors.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

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Section: Introductionmentioning

confidence: 99%

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Chen

Gao

et al. 2021

Front. Oncol.

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“…Currently, only a few studies are available focusing on laparoscopic re-resection in rHCC [29][30][31][32]. However, a recent meta-analysis based on Eastern patients showed that laparoscopic re-resection for rHCC is associated with fewer overall complication and a shorter hospitalization but displayed similar 90-day mortality compared to conventional re-resection [33].…”

Section: Discussionmentioning

confidence: 99%

The role of re-resection in recurrent hepatocellular carcinoma

Bednarsch

Czigány

Heij

et al. 2022

Langenbecks Arch Surg

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Purpose While liver resection is a well-established treatment for primary HCC, surgical treatment for recurrent HCC (rHCC) remains the topic of an ongoing debate. Thus, we investigated perioperative and long-term outcome in patients undergoing re-resection for rHCC in comparative analysis to patients with primary HCC treated by resection. Methods A monocentric cohort of 212 patients undergoing curative-intent liver resection for HCC between 2010 and 2020 in a large German hepatobiliary center were eligible for analysis. Patients with primary HCC (n = 189) were compared to individuals with rHCC (n = 23) regarding perioperative results by statistical group comparisons and oncological outcome using Kaplan–Meier analysis. Results Comparative analysis showed no statistical difference between the resection and re-resection group in terms of age (p = 0.204), gender (p = 0.180), ASA category (p = 0.346) as well as main preoperative tumor characteristics, liver function parameters, operative variables, and postoperative complications (p = 0.851). The perioperative morbidity (Clavien-Dindo ≥ 3a) and mortality were 21.7% (5/23) and 8.7% (2/23) in rHCC, while 25.4% (48/189) and 5.8% (11/189) in primary HCC, respectively (p = 0.851). The median overall survival (OS) and recurrence-free survival (RFS) in the resection group were 40 months and 26 months, while median OS and RFS were 41 months and 29 months in the re-resection group, respectively (p = 0.933; p = 0.607; log rank). Conclusion Re-resection is technically feasible and safe in patients with rHCC. Further, comparative analysis displayed similar oncological outcome in patients with primary and rHCC treated by liver resection. Re-resection should therefore be considered in European patients diagnosed with rHCC.

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“…While patients with early HCC are asymptomatic, patients in the intermediate and advanced stages present with liver pain, hepatomegaly, digestive symptoms, and/or systemic symptoms; additionally, some patients may be accompanied by paraneoplastic syndrome [15]. At present, open surgical resection offers the best curative potential for HCC [16,17]. However, hyperglycemia is common after hepatectomy because of the reduction in liver volume, in uence of immune function, and stress caused by the operation [12,18].…”

Section: Discussionmentioning

confidence: 99%

Hyperglycemia-Associated Early Hepatocellular Carcinoma Recurrence After Open Radical Hepatectomy

Liu¹,

Xie²,

Zhang³

et al. 2020

Preprint

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BackgroundWe investigated the impact of elevated glucose levels on the early recurrence of hepatocellular carcinoma (HCC)after open radical hepatectomy.MethodsThis retrospective cohort study analyzed. The clinical data of 112 patients with hepatocellular carcinoma who underwent open radical hepatectomy from January 2013 to December 2014 at the Affiliated Hospital of Qingdao University. After radical resection of the hepatocellular carcinoma, 86 patients with an average fasting blood glucose(FBG) level of 3.9–6.1 mmol/L and 26 patients with an FBG level ≥ 6.1 mmol/L were divided into the normal group and hyperglycemic group, respectively. The recurrence rate of hepatocellular carcinoma was compared between the two groups 1 and 2 years after the operation.ResultsThe postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86), respectively, in the normal group and42.3% (11/26) and 61.5% (16/26), respectively, in the hyperglycemic group; there were significant differences between the two groups (χ2 = 6.719,P = 0.01;χ2 = 6.427༌P = 0.011). The univariate analysis showed that FBG, history of alcohol drinking, extent of hepatectomy, histopathological differentiation, maximal tumor diameter, satellite lesion, and the postoperative adjuvant treatment were risk factors affecting the tumor-free survival rate after open radical resection of hepatocellular carcinoma (P < .05).The results of the multivariate analysis showed that FBG levels ≥ 6.1 mmol/L, low histopathological differentiation, and no postoperative adjuvant treatment were independent risk factors affecting tumor-free survival rate after radical resection of hepatocellular carcinoma (P < .05).ConclusionAn elevated FBG level has a stimulating effect on the early recurrence of tumor after open radical resection of hepatocellular carcinoma. Therefore, postoperative monitoring and blood glucose control may facilitate a decrease in the early recurrence rate in patients with hepatocellular carcinoma.

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Comparison of clinical outcomes of laparoscopic versus open surgery for recurrent hepatocellular carcinoma: a meta-analysis

Cited by 22 publications

References 35 publications

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

The role of re-resection in recurrent hepatocellular carcinoma

Hyperglycemia-Associated Early Hepatocellular Carcinoma Recurrence After Open Radical Hepatectomy

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