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

医学 围手术期 肝细胞癌 内科学 胃肠病学 腹水 代谢综合征 外科 回顾性队列研究 肥胖
作者
Giammauro Berardi,Tommy Ivanics,Gonzalo Sapisochín,Francesca Ratti,Carlo Sposito,Martina Nebbia,D.M. D'Souza,Franco Pascual,Samer Tohme,F. D’Amico,Remo Alessandris,Valentina Panetta,Ilaria Simonelli,Céleste Del Basso,Nadia Russolillo,Guido Fiorentini,Matteo Serenari,Fernando Rotellar,Giuseppe Zimitti,Simone Famularo
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:278 (5): e1041-e1047 被引量:8
标识
DOI:10.1097/sla.0000000000005861
摘要

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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