Laparoscopic Liver Resection for Hepatocellular Carcinoma in Cirrhosis: Long-Term Outcomes (original) (raw)
Article navigation
Review Articles| April 29 2011
Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy
Search for other works by this author on:
Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy
Search for other works by this author on:
Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy
Search for other works by this author on:
Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy
Search for other works by this author on:
Dig Surg (2011) 28 (2): 134–140.
Abstract
Background: Few data regarding survival or pattern of recurrence after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) on cirrhosis have been reported so far. Methods: A retrospective analysis of a prospectively maintained database of 109 laparoscopic interventional procedures performed for HCC in cirrhotic liver between 2000 and 2008 was conducted. Results: Sixty-five patients underwent an LLR. Morbidity rates were 20% (13/65), whereas there was only 1 death (1.5%). Reoperation was required in 2 patients. The overall mean postoperative hospital stay was 8.2 (2.6; 3–15) days. The actuarial overall 1-, 3-, and 5-year survival rates were 95, 70, and 55%, respectively, with a median overall survival of 75 months. Excluding the one hospital death, the actuarial 1-, 3-, and 5-year disease-free survival rates were 81, 62, and 32%, respectively, with a median overall disease-free survival of 42 months (95% confidence interval, CI: 18–65). On multivariate analysis, tumor grade (OR: 3.5, 95% CI: 1.1–10.7, p = 0.026) and microvascular invasion (OR: 4.9, 95% CI: 1.2–18.8, p = 0.020) resulted as independent predictors of overall survival. On multivariate analysis, gender (OR: 3.4, 95% CI: 1.1–10.2, p = 0.023), satellite tumor (OR: 4.3, 95% CI: 1.5–12.3, p = 0.006), microvascular invasion (OR: 3.3, 95% CI: 1.0–10.1, p = 0.036) and surgical margin (OR: 3.7, 95% CI: 1.0–10.1, p = 0.036) were identified as independent prognostic predictors of better disease-free survival. After a median follow-up of 29 (range 3–81) months, 31 (48%) out of 64 patients had recurrence. The cumulative recurrence rates at 1, 3, and 5 years were 19, 39, and 68%, respectively. Conclusion: This prospective observational study has confirmed the feasibility and safety of LLR in selected patients with HCC in cirrhotic liver, and proved that it can warrant long-term outcome similar to those reported with the traditional open approach.
References
Cherqui D, Laurent A, Tayar C, Chang S, Van Nhieu JT, Loriau J, et al: Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease. Ann Surg 2006;243:499–506.
Chan ACY, Poon RTP, Ng KKC, Lo CM, Fan ST, Wong J: Changing paradigm in the management of hepatocellular carcinoma improves the survival benefit of early detection by screening. Ann Surg 2008;247:666–673.
Yao FY, Bass NM, Nikolai B, Davern TJ, Kerlan R, Wu V, et al: Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl 2002;8:873–883.
Cha CH, Ruo L, Fong Y, Jarnagin WR, Shia J, Blumgart LH, et al: Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 2003;238:315–321, discussion 321–323.
Dagher I, Lainas P, Carloni A, Caillard C, Champault A, Smadja C, et al: Laparoscopic liver resection for hepatocellular carcinoma. Surg Endosc 2008;22:372–378.
Kaneko H, Takagi S, Otsuka Y, Tsuchiya M, Tamura A, Katagiri T, et al: Laparoscopic liver resection of hepatocellular carcinoma. Am J Surg 2005;189:190–194.
Belli G, Fantini C, D’Agostino A, Cioffi L, Langella S, Russolillo N, et al: Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrhosis: short- and middle-term results. Surg Endosc 2007;21:2004–2011.
Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau W-Y, et al: The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000;2:333–339.
Belli G, Fantini C, D’Agostino A, Belli A, Russolillo N: Laparoscopic liver resections for hepatocellular carcinoma (HCC) in cirrhotic patients. HPB (Oxford) 2004;6:236–246.
Belli G, Fantini C, D’Agostino A, Belli A, Cioffi L, Russolillo N: Laparoscopic left lateral hepatic lobectomy: a safer and faster technique. J Hepatobiliary Pancreat Surg 2006;13:149–154.
Belli G, Fantini C, D’Agostino A, Cioffi L, Limongelli P, Russo G, et al: Laparoscopic segment VI liver resection using a left lateral decubitus position: a personal modified technique. J Gastrointest Surg 2008;12:2221–2226.
Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Ando T, et al: Laparoscopic partial hepatectomy. Hepatogastroenterology 1998;45:29–33.
Dindo D, Demartines N, Clavien P: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205–213.
Edmondson HA, Steiner PE: Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954;7:462–503.
Viganò L, Tayar C, Laurent A, Cherqui D: Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 2009;16:410–421.
Dagher I, Belli G, Fantini C, Laurent A, Tayar C, Lainas P, et al: Laparoscopic hepatectomy for hepatocellular carcinoma: a European experience. J Am Coll Surg 2010;211:16–23.
Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, et al: Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 2009;250:856–860.
Fong Y, Sun RL, Jarnagin W, Blumgart LH: An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999;229:790–799.
Grazi GL, Ercolani G, Pierangeli F, Del Gaudio M, Cescon M, Cavallari A, et al: Improved results o liver resection for hepatocellular carcinoma on cirrhosis give the procedure added value. Ann Surg 2001;234:71–78.
Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, et al: Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 2009;96:1041–1048.
Lai ECS, Fan ST, Lo CM, Chu KM, Liu CL, Wong J: Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg 1995;221:291–298.
Nagao T, Inoue S, Yoshimi F, Sodeyama M, Omori Y, Mizuta T, et al: Postoperative recurrence of hepatocellular carcinoma. Ann Surg 1990;211:28–33.
Okada S, Shimada K, Yamamoto J, et al: Predictive factors for postoperative recurrence of hepatocellular carcinoma. Gastroenterology 1994;106:1618–1624.
Nagasue N, Uchida M, Makino Y, et al: Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993;105:488–494.
Poon RT, Fan ST, Ng IO, Wong J: Significance of resection margin in hepatectomy for hepatocellular carcinoma: a critical reappraisal. Ann Surg 2000;231:544–551.
Shi M, Guo RP, Lin XJ, Zhang YQ, Chen MS, Zhang CQ, et al: Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma. A prospective randomized trial. Ann Surg 2007;245:36–43.
Fukuda S, Itamoto T, Amano H, Kohashi T, Ohdan H, Tashiro H, et al: Clinicopathologic features of hepatocellular carcinoma patients with compensated cirrhosis surviving more than 10 years after curative hepatectomy. World J Surg 2007;31:345–352.
Nagao T, Inoue S, Yoshimi F, Sodeyama M, Omori Y, Mizuta T, et al: Postoperative recurrence of hepatocellular carcinoma. Ann Surg 1990;211:28–33.
Shimada M, Takenaka K, Taguchi K, Fujiwara Y, Gion T, Kajiyama K, et al: Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg 1998;227:80–95.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
Sign in
Digital Version
Pay-Per-View Access
$45.00
1 Karger Article Bundle Token
$170
Rental
This article is also available for rental through DeepDyve. 