Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

Abstract

LLR vs. OLR 44 vs. 31% TO vs. No TO 33 vs. 18% Highlights Homogeneous population of 425 resected patients with early-stage HCC in cirrhosis. Textbook outcome following liver resection was achieved in 32.9% of patients. The minimal invasive approach increases the chance of achieving a textbook outcome. Textbook outcome following liver resection improves DFS and probability of cure. Minimal invasive treatments of early HCC have a promising curative effect. Lay summary The overall quality of surgical care, as measured by TO, plays a pivotal role in the prognosis and, in particular, on the probability of statistical cure of patients with resectable early-stage HCC occurring in cirrhosis. By influencing TO, laparoscopy has an indirect impact on the probability of cure and long-term management of these patients. This study strongly supports the promising curative role of mini-invasive treatments for early-stage HCC, such as low-difficulty LLR.

Reply to: ‘Letter regarding “Benchmark performance of laparoscopic left lateral sectionectomy and right hepatectomy in expert centers”’

“…9 Notably, the criteria of TO could be further adjusted to the aetiology of the malignancy. 10 Likewise, we acknowledge that the present benchmark values will require revision after further prospective and randomized LLR evaluation.…”

Textbook outcome in hepato-pancreato-biliary surgery: systematic review

“…Among hepatobiliary procedures, previous liver resection, ICC, gallbladder carcinoma, increasing tumour size (more than 3 cm), minor resection of posterior/superior segments, non-anatomical resection, (anatomical) major resection, biliary reconstruction, and major vascular invasion were all associated with decreased likelihood of achieving TO (OR 1 or less) 9 , 15 , 23 , 33 , 39 .…”

“…All studies found better TO rates in patients undergoing a laparoscopic procedure compared with an open procedure. Two of these studies included only patients with ICC 32 , 35 and three studies compared the laparoscopic and open approach in patients with HCC, portal hypertension and cirrhosis, and patients with any liver disease 9 , 31 , 33 . In both studies focusing on HCC, the laparoscopic approach proved to be a predictor of TO in multivariable analysis with Ors of 2.81 (95 per cent c.i.…”

“…1.29 to 6.12) and 5.6 (95 per cent c.i. 1.7 to 18.2) 31 , 33 . One study investigating patients who underwent HPB surgery for any indication reported that a laparoscopic approach was an independent predictor of TO achievement with an OR of 1.52 (95 per cent c.i.…”

Efficacy of Laparoscopic Hepatectomy versus Open Surgery for Hepatocellular Carcinoma With Cirrhosis: A Meta-analysis of Case-Matched Studies

“…Twelve studies were excluded due to overlapping data, inclusion of patients without cirrhosis, unavailable statistical data, non-comparative studies, non-case matched studies (8,9,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). Sixteen studies were eventually included (15)(16)(17)(18)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). The PRISMA flowchart of the literature review is presented in Figure 1.…”