Citations 1
Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome
Nebbia, Martina , D'Souza, D.M. , Pascual, Franco , Tohme, Samer , Alessandris, Remo , Simonelli, Ilaria , Basso, Céleste Del , Serenari, Matteo , Rotellar, Fernando , Zimitti, Giuseppe, Famularo, Simone , Hoffman, Daniel , Onkendi, Edwin, López‐Ben, Santiago , Caula, Cèlia , Rompianesi, Gianluca , Chopra, Asmita , Hilal, Mohammad Abu , Torzilli, Guido, Corvera, Carlos U. , Helton, Scott , Troisi, Roberto , Simo, Kerri A. , Conrad, Claudius , Cleary, Sean, Kwon, Choon Hyuck David , Cherqui, Daniel , Ferrone, Cristina R. , Alessandris, Remo , Simonelli, Ilaria , Serenari, Matteo , Rotellar, Fernando , Lopez Ben, Santiago , Berardi, Giammauro , Ivanics, Tommy , Sapisochín, Gonzalo , Ratti, Francesca , Sposito, Carlo , D‘Amico, F. , Panetta, Valentina , Russolillo, Nadia , Fiorentini, Guido , Zimmitti, Giuseppe , Torzilli, Guido, Alseidi, Adnan A. , Cescon, Matteo , Ferrero, Alessandro , Ettorre, Giuseppe M , Cillo, Umberto , Geller, David A. , Serrano, Pablo E , Mazzaferro, Vincenzo , Aldrighetti, Luca , Kingham, T. Peter
Annals of Surgery | March 30, 2023 | Volume: 278 | Issue: 5 | Pages: e1041-e1047
Objective: To compare minimally invasive (MILR) and open liver resections (OLRs) for hepatocellular carcinoma (HCC) in patients with metabolic syndrome (MS). Background: Liver resections for HCC on MS are associated with high perioperative morbidity and mortality. No data on the minimally invasive approach in this setting exist. Material and Methods: A multicenter study involving 24 institutions was conducted. Propensity scores were calculated, and inverse probability weighting was used to weight comparisons. Short-term and long-term outcomes were investigated. Results: A total of 996 patients were included: 580 in OLR and 416 in MILR. After weighing, groups were well matched. Blood loss was similar between groups (OLR 275.9±3.1 vs MILR 226±4.0, P=0.146). There were no significant differences in 90-day morbidity (38.9% vs 31.9% OLRs and MILRs, P=0.08) and mortality (2.4% vs 2.2% OLRs and MILRs, P=0.84). MILRs were associated with lower rates of major complications (9.3% vs 15.3%, P=0.015), posthepatectomy liver failure (0.6% vs 4.3%, P=0.008), and bile leaks (2.2% vs 6.4%, P=0.003); ascites was significantly lower at postoperative day 1 (2.7% vs 8.1%, P=0.002) and day 3 (3.1% vs 11.4%, P<0.001); hospital stay was significantly shorter (5.8±1.9 vs 7.5±1.7, P<0.001). There was no significant difference in overall survival and disease-free survival. Conclusions: MILR for HCC on MS is associated with equivalent perioperative and oncological outcomes to OLRs. Fewer major complications, posthepatectomy liver failures, ascites, and bile leaks can be obtained, with a shorter hospital stay. The combination of lower short-term severe morbidity and equivalent oncologic outcomes favor MILR for MS when feasible.