Article
Author: Serenari, Matteo ; Crespi, Michele ; I Troisi, Roberto ; Ercolani, Giorgio ; Lai, Quirino ; Vitale, Alessandro ; Grazi, Gian Luca ; Della Valle, Raffaele ; Zimmitti, Giuseppe ; Memeo, Riccardo ; Cipriani, Federica ; Conticchio, Maria ; Ardito, Francesco ; Cescon, Matteo ; Torzilli, Guido ; Romano, Fabrizio ; Ruzzenente, Andrea ; Molfino, Sarah ; Nicolini, Daniele ; Romano, Maurizio ; Cassese, Gianluca ; Perri, Pasquale ; Germani, Paola ; Ferrero, Alessandro ; C Giglio, Mariano ; Troci, Albert ; Famularo, Simone ; Lauterio, Andrea ; Di Gioia, Giulio ; Conci, Simone ; De Angelis, Michela ; Abu Hilal, Mohamed ; Rossi, Massimo ; La Barba, Giuliano ; Tarchi, Paola ; Baiocchi, Gianluca ; De Carlis, Luciano ; Jovine, Elio ; Fontana, Andrea Pierluigi ; Vivarelli, Marco ; Aldrighetti, Luca ; Maestri, Marcello ; Garancini, Mattia ; Iaria, Maurizio ; Giuliante, Felice ; Zanello, Matteo ; Zanus, Giacomo ; Fumagalli, Luca ; Cillo, Umberto ; Izzo, Francesco ; Belli, Andrea ; Chiarelli, Marco ; Boccia, Luigi
BACKGROUND:Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far.
METHODS:Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders. The primary outcome was a composite endpoint including post-hepatectomy liver failure, severe postoperative complications and in-hospital mortality.
RESULTS:627 patients were included (459 undergoing OLR and 168 receiving MILS). After IPTW, no difference was found in the composite endpoint between MILS and OLR (OR 0.86 [95%CI 0.46-1-60]; p = 0.62). MILS reduced the risk of receiving intra-operative transfusions (OR 0.28 [95%CI 0.13-0.58]; p < 0.001) and of developing postoperative ascites (OR 0.56 [95%CI 0,32-0,98]; p = 0.039), with reduced length of stay (OR 0.82 [95%CI 0.66-1.01]; p = 0.045). The survival analysis showed no differences between MILS and OLR for both OS (p = 0.13) and DFS (p = 0.491).
CONCLUSION:MILS was shown to be safe and feasible for selected non-metastatic HCC patients staged BCLC B and C, reducing the risk of perioperative transfusions and postoperative ascites, and shortening the length of stay.