Risk factors and long-term implications of unplanned conversion during laparoscopic liver resection for hepatocellular carcinoma located in anterolateral liver segments

Abstract

Purpose The impact of conversion on perioperative and long-term oncologic outcomes is controversial. Thus, we compared these outcomes between laparoscopic (Lap), unplanned conversion (Conversion), and planned open (Open) liver resection for hepatocellular carcinoma (HCC) located in anterolateral (AL) liver segments and aimed to identify risk factors for unplanned conversion. Methods We retrospectively studied 374 patients (Lap, 299; Open, 62; Conversion, 13) who underwent liver resection for HCC located in AL segments between 2004 and 2018. Results Compared to the Lap group, the Conversion group showed greater values for operation time ( p < 0.001), blood loss ( p = 0.021), transfusion rate ( p = 0.009), postoperative complication rate ( p = 0.008), and hospital stay ( p = 0.040), with a lower R0 resection rate ( p < 0.001) and disease-free survival ( p = 0.001). Compared with the Open group, the Conversion group had a longer operation time ( p = 0.012) and greater blood loss ( p = 0.024). Risk factors for unplanned conversion were large tumor size (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.05–1.74; p = 0.020), multiple tumors (OR, 5.95; 95% CI, 1.45–24.39; p = 0.013), and other organ invasion (OR, 15.32; 95% CI, 1.80–130.59; p = 0.013). Conclusion In conclusion, patients who experienced unplanned conversion during LLR for HCC located in AL segments showed poor perioperative and long-term outcomes compared to those who underwent planned laparoscopic and open liver resection. Therefore, open liver resection should be considered in patients with risk factors for unplanned conversion.

Association between Unplanned Conversion and Patient Survival after Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Propensity Score Matched Analysis

“…In this study, the surgical outcomes following UPC included greater intraoperative blood loss, greater transfusion requirements, longer hospital stay, and increased morbidity compared with LLR, consistent with the results of previous studies [9,[21][22][23]. These results are somewhat predictable because the most common reason for UPC is uncontrolled bleeding during LLR.…”

“…Nevertheless, the impact of conversion to open surgery on long-term outcomes remains controversial. Several studies have demonstrated that conversion to open surgery may be associated with adverse long-term oncologic outcomes in laparoscopic colorectal surgery [7][8][9]. However, other studies have reported similar oncological outcomes after colectomy between converted and non-converted patients [10,11].…”

Editorial on “Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis”

“…No information was given on preoperative chemoembolization, radiofrequency ablation, or percentage of conversion from laparoscopic to open surgery. As it has been already shown by Shin et al , patients who experienced unplanned conversion during LLR showed poor perioperative and long-term outcomes compared to those who underwent planned laparoscopic and OLR ( 12 ).…”

How to minimize conversion to open surgery during laparoscopic liver resection: the point of view of hemostasis

“…As in this study [ 3 ], one of the most important reasons for conversion to open surgery is bleeding during surgery, and the causes of bleeding are various, such as the size, location, and number of tumors, and the degree of cirrhosis of the liver. Minimizing bleeding and, if there is bleeding, quick hemostasis can help to reduce unplanned conversion to open surgery [ 4 – 6 ].…”