Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis: A Single-Center Experience over a 10-Year Period

Yamashita, Yo Ichi; Ikeda, Tetsuo; Kurihara, Toshio; Yoshida, Yasuhiko; Takeishi, Kazuki; Itoh, Shinji; Harimoto, Norifumi; Kawanaka, Hirofumi; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1016/j.jamcollsurg.2014.09.003

Cited by 58 publications

(33 citation statements)

References 34 publications

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“…As previously mentioned, there have been several studies that compared the long-term outcomes of LH versus OH for HCC [3,4,7,8,27], even in cirrhotic patients [9,12,29]. In addition, in this study, the OS and DFS rates were similar between the two treatment groups.…”

Section: Discussionsupporting

confidence: 64%

“…With the rapid development of surgical procedures and equipment for LH, minimally invasive surgery is now commonly applied in liver surgery [5], and several reports indicated good short- and long-term outcomes after LH compared with OH [3,4,5,6,7,8,9,12,26,27]. However, validation of LH for cirrhotic patients is essential because cirrhotic patients are at an exceptionally high risk for postoperative complications such as intractable ascites, pleural effusion and liver failure after OH [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…However, validation of LH for cirrhotic patients is essential because cirrhotic patients are at an exceptionally high risk for postoperative complications such as intractable ascites, pleural effusion and liver failure after OH [1,2]. Several retrospective studies reported less intraoperative blood loss, reduced risk of transfusion, lower morbidity, and shorter hospital stay with LH as opposed to OH for HCC in cirrhotic patients [9,11], in accordance with the findings of previously reported retrospective, case-matched analyses [6,12]. However, almost all of these studies included a very limited number of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the OS (5-year: 46%) and DFS (3-year: 42%) rates in the LH group in the present study were poor compared with those reported in other studies. The 3- and 5-year OS rates after LH for cirrhotic patients ranged from 67 to 100% and from 76.6 to 92.2%, respectively, whereas the 3- and 5-year DFS rates ranged from 61.7 to 72.6% and from 33 to 54.5% [9,12,29]. These discrepancies can be explained by the shorter mean follow-up period of 34 months and the inclusion of only patients who underwent partial hepatic resection (nonanatomical resection) in our study, whereas other reports included patients who underwent anatomical resection during LH.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the long-term outcome after LH is reportedly similar to that of OH [3,4,7,8]. In addition, the safety and efficacy of LH for cirrhotic patients, compared with OH, have recently been reported [9,10,11,12], indicating that the procedure remains challenging in advanced cases. Selection bias will be present in terms of preoperative liver function and difficulty of hepatic resection.…”

Section: Introductionmentioning

confidence: 95%

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Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

Tanaka¹,

Takemura²,

Shinkawa³

et al. 2015

Eur Surg Res

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Background/Purpose: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging. Methods: Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH. Results: Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606). Conclusions: LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

Tanaka¹,

Takemura²,

Shinkawa³

et al. 2015

Eur Surg Res

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Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Yamashita

Imai

Yusa

et al. 2018

Annals of Gastroent Surgery

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BackgroundSmall hepatocellular carcinomas (HCC ≤3 cm) are generally considered to have low malignant potential; however, some of them display pathological microvascular invasion (MVI).MethodsBetween 1991 and 2013, 414 patients with a single HCC ≤3 cm underwent curative hepatic resection (HR). Predictors for MVI were identified. Using another cohort (149 patients during 2000‐2014), our predictors for MVI in HCC ≤3 cm were validated. In 428 patients with a single HCC ≤3 cm who had predictors for MVI, survival was compared among anatomical HR (n = 149), partial HR (n = 227), and radiofrequency ablation (RFA) (n = 52).ResultsThe positive rate of MVI reached 40.6% (168/414 patients). Independent predictors for MVI were as follows: tumor diameter ≥2 cm (odds ratio 1.84, P = .0052), alpha‐fetoprotein (AFP) ≥200 ng/mL (odds ratio 1.82, P = .0466), and des‐gamma‐carboxy prothrombin (DCP) ≥40 mAU/mL (odds ratio 1.79, P = .0126). Matching at least one predictor among these three could predict MVI in HCC ≤3 cm well (sensitivity 82.8%, positive predictive value [PPV] 48.7%). This criterion could also predict MVI in HCC ≤3 cm well in another cohort (sensitivity 82.8%, PPV 30.3%). In patients with single HCC ≤3 cm matching our criterion for predicting MVI, anatomical HR led to significantly better survival in both disease‐free (hazard ratio 0.689, P = .0231) and overall (hazard ratio 0.589, P = .0316) survivals.ConclusionMatching at least one factor among three (tumor diameter ≥2 cm, AFP ≥200 ng/mL, or DCP ≥40 mAU/mL) can predict MVI in HCC ≤3 cm. In such patients, anatomical HR would be recommended to improve survival.

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Resection of Hepatocellular Carcinoma

Lubezky

Goykhman

Nakache

et al. 2016

Hepatocellular Carcinoma

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Long-Term Favorable Surgical Results of Laparoscopic Hepatic Resection for Hepatocellular Carcinoma in Patients with Cirrhosis: A Single-Center Experience over a 10-Year Period

Cited by 58 publications

References 34 publications

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

Microvascular invasion of single small hepatocellular carcinoma ≤3 cm: Predictors and optimal treatments

Resection of Hepatocellular Carcinoma

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