TY - JOUR
T1 - Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis
AU - Benedetti Cacciaguerra, Andrea
AU - Görgec, Burak
AU - Lanari, Jacopo
AU - Cipriani, Federica
AU - Russolillo, Nadia
AU - Mocchegiani, Federico
AU - Zimmitti, Giuseppe
AU - Alseidi, Adnan
AU - Ruzzenente, Andrea
AU - Edwin, Bjorn
AU - D’Hondt, Mathieu
AU - Besselink, Marc G.
AU - Giuliante, Felice
AU - Fuks, David
AU - Rotellar, Fernando
AU - López-Ben, Santiago
AU - Ferrero, Alessandro
AU - Aldrighetti, Luca
AU - Cillo, Umberto
AU - Vivarelli, Marco
AU - Abu Hilal, Mohammed
N1 - Publisher Copyright: © 2021 Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2021
Y1 - 2021
N2 - Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P =.042), lower overall and severe complication (P <.001,.020), such as surgical site infection, acute kidney injury and liver failure were observed, parallel to a shorter length of hospital stay. Stratifying patients based on the type of resection, less severe complications was observed only after laparoscopic left hepatectomy (P =.044), while the advantages of laparoscopy tend to decrease during right hepatectomy. Subgroup analysis of long-term survivals following liver resection for hepatocellular carcinoma showed no difference between mjLLR and mjOLR. Conclusions: This multicenter experience suggests potential short-term benefits of mjLLR in cirrhotic patients compared to mjOLR, without compromising long-term outcome. These findings might have interesting clinical implications for the management of patients with chronic liver disease.
AB - Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long-term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss (P =.042), lower overall and severe complication (P <.001,.020), such as surgical site infection, acute kidney injury and liver failure were observed, parallel to a shorter length of hospital stay. Stratifying patients based on the type of resection, less severe complications was observed only after laparoscopic left hepatectomy (P =.044), while the advantages of laparoscopy tend to decrease during right hepatectomy. Subgroup analysis of long-term survivals following liver resection for hepatocellular carcinoma showed no difference between mjLLR and mjOLR. Conclusions: This multicenter experience suggests potential short-term benefits of mjLLR in cirrhotic patients compared to mjOLR, without compromising long-term outcome. These findings might have interesting clinical implications for the management of patients with chronic liver disease.
KW - laparoscopic liver resection
KW - liver cirrhosis
KW - major liver resection
KW - open liver resection
KW - surgical oncology
UR - http://www.scopus.com/inward/record.url?scp=85121464584&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/jhbp.1087
DO - https://doi.org/10.1002/jhbp.1087
M3 - Article
C2 - 34855277
SN - 1868-6974
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
ER -