Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis. (17th December 2021)

• Record Type: Journal Article
• Authors: Benedetti Cacciaguerra, Andrea; Görgec, Burak; Lanari, Jacopo; Cipriani, Federica; Russolillo, Nadia; Mocchegiani, Federico; Zimmitti, Giuseppe; Alseidi, Adnan; Ruzzenente, Andrea; Edwin, Bjorn; D'Hondt, Mathieu; Besselink, Marc G.; Giuliante, Felice; Fuks, David; Rotellar, Fernando; López‐Ben, Santiago; Ferrero, Alessandro; Aldrighetti, Luca; Cillo, Umberto; Vivarelli, Marco; Abu Hilal, Mohammed
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 29:Number 11(2022)
• Page Start: 1226
• Page End: 1239
• Publication Date: 2021-12-17
• Subjects: laparoscopic liver resection -- liver cirrhosis -- major liver resection -- open liver resection -- surgical oncology; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.1087
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Objective: Major hepatectomy in cirrhotic patients still represents a great challenge for liver surgeons. Hence, the aim in the present study is to investigate the clinical impact of major hepatectomy and to assess whether the surgical approach influences the outcome of cirrhotic patients. Methods: Multicenter retrospective study including cirrhotic patients undergoing major laparoscopic (mjLLR) and open liver resection (mjOLR) in 14 Western liver centers was performed (2009–2020). Clinical, demographic, and perioperative data were compared using propensity score matching (PSM). Long‐term outcome after resection for hepatocellular carcinoma was analyzed. Results: Overall, 352 patients were included; 108 after mjLLR and 244 after mjOLR. After PSM, 88 patients were matched in each group. In the mjLLR group, compared to mjOLR, less blood loss ( P = .042), lower overall and severe complication ( P < .001, .020), such as surgical site infection, acute kidney injury and liver failure were observed, parallel to a shorter length of hospital stay. Stratifying patients based on the type of resection, less severe complications was observed only after laparoscopic left hepatectomy ( P = .044), while the advantages of laparoscopy tend to decrease during right hepatectomy. Subgroup analysis of long‐term survivals following liver resection for hepatocellular carcinoma showed no difference between mjLLR and mjOLR. Conclusions: This multicenter experience suggests potential short‐term benefits of mjLLR in cirrhotic patients compared to mjOLR, without compromising long‐term outcome. These findings might have interesting clinical implications for the management of patients with chronic liver disease.