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Multicenter Study
. 2023 Nov 1;278(5):e1041-e1047.
doi: 10.1097/SLA.0000000000005861. Epub 2023 Mar 30.

Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome

Giammauro Berardi  1   2 , Tommy Ivanics  3 , Gonzalo Sapisochin  3 , Francesca Ratti  4 , Carlo Sposito  5   6 , Martina Nebbia  7 , Daniel M D'Souza  8 , Franco Pascual  9 , Samer Tohme  10 , Francesco Enrico D'Amico  11 , Remo Alessandris  11 , Valentina Panetta  12 , Ilaria Simonelli  12 , Celeste Del Basso  2 , Nadia Russolillo  13 , Guido Fiorentini  14 , Matteo Serenari  15 , Fernando Rotellar  16 , Giuseppe Zimitti  17 , Simone Famularo  18 , Daniel Hoffman  19 , Edwin Onkendi  20 , Santiago Lopez-Ben  21 , Celia Caula  21 , Gianluca Rompianesi  22 , Asmita Chopra  23 , Mohammed Abu Hilal  17 , Guido Torzilli  18 , Carlos Corvera  19 , Adnan Alseidi  19 , Scott Helton  24 , Roberto I Troisi  22 , Kerri Simo  23 , Claudius Conrad  25 , Matteo Cescon  15 , Sean Cleary  14 , Choon H D Kwon  26 , Alessandro Ferrero  13 , Giuseppe M Ettorre  2 , Umberto Cillo  11 , David Geller  10 , Daniel Cherqui  9 , Pablo E Serrano  8 , Cristina Ferrone  7 , Vincenzo Mazzaferro  5   6 , Luca Aldrighetti  4 , T Peter Kingham  1
Affiliations
Multicenter Study

Minimally Invasive Versus Open Liver Resections for Hepatocellular Carcinoma in Patients With Metabolic Syndrome

Giammauro Berardi et al. Ann Surg. .

Abstract

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the patients included in the study. HCC, hepatocellular carcinoma; MS, metabolic syndrome; MIS, minimally invasive surgery
Figure 2.
Figure 2.
Inverse probability weighted Kaplan-Meier curves of overall survival according to treatment assignment. Overall survival HR=0.90, 95% CI 0.69–1.19, p=0.461. Number of patients represent the number in the synthetic pseudo-population generated by the inverse probability treatment weighting
Figure 3.
Figure 3.
Inverse probability weighted Kaplan-Meier curves of disease-free survival according to treatment assignment. Disease free survival HR=0.84 95% CI 0.66–1.06 p=0.138. Number of patients represent the number in the synthetic pseudo-population generated by the inverse probability treatment weighting
See this image and copyright information in PMC

Comment in

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