Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma in the Setting of Portal Vein Hypertension: Results of an International Multi-institutional Analysis

Ann Surg Oncol. 2020 Sep;27(9):3360-3371. doi: 10.1245/s10434-020-08444-3. Epub 2020 Apr 9.

Abstract

Background: Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared.

Methods: Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized.

Results: Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08].

Conclusion: An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Carcinoma, Hepatocellular* / complications
  • Carcinoma, Hepatocellular* / surgery
  • Female
  • Hepatectomy / methods*
  • Humans
  • Hypertension, Portal / complications*
  • Liver Neoplasms* / complications
  • Liver Neoplasms* / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Platelet Count
  • Portal Pressure
  • Portal Vein / surgery
  • Retrospective Studies
  • Thrombocytopenia / complications*
  • Treatment Outcome