Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis

Andrea Benedetti Cacciaguerra, Burak Görgec, Jacopo Lanari, Federica Cipriani, Nadia Russolillo, Federico Mocchegiani, Giuseppe Zimmitti, Adnan Alseidi, Andrea Ruzzenente, Bjorn Edwin, Mathieu D’Hondt, Marc G. Besselink, Felice Giuliante, David Fuks, Fernando Rotellar, Santiago López-Ben, Alessandro Ferrero, Luca Aldrighetti, Umberto Cillo, Marco VivarelliMohammed Abu Hilal

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11 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Early online date2021
DOIs
Publication statusE-pub ahead of print - 2021

Keywords

  • laparoscopic liver resection
  • liver cirrhosis
  • major liver resection
  • open liver resection
  • surgical oncology

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