Multicenter Propensity Score-Based Study of Laparoscopic Repeat Liver Resection for Hepatocellular Carcinoma: A Subgroup Analysis of Cases with Tumors Far from Major Vessels
Arimasa Miyama 1 , Zenichi Morise 1 , Luca Aldrighetti 2 , Giulio Belli 3 , Francesca Ratti 2 , Tan-To Cheung 4 , Chung-Mau Lo 4 , Shogo Tanaka 5 , Shoji Kubo 5 , Yukiyasu Okamura 6 , Katsuhiko Uesaka 6 , Kazuteru Monden 7 , Hiroshi Sadamori 7 , Kazuki Hashida 8 , Kazuyuki Kawamoto 8 , Naoto Gotohda 9 , KuoHsin Chen 10 11 , Akishige Kanazawa 12 , Yutaka Takeda 13 , Yoshiaki Ohmura 13 , Masaki Ueno 14 , Toshiro Ogura 15 , Kyung-Suk Suh 16 , Yutaro Kato 17 , Atsushi Sugioka 17 , Andrea Belli 18 , Hiroyuki Nitta 19 , Masafumi Yasunaga 20 , Daniel Cherqui 21 22 , Nasser Abdul Halim 21 , Alexis Laurent 22 , Hironori Kaneko 23 , Yuichiro Otsuka 23 , Ki-Hun Kim 24 , Hwui-Dong Cho 24 , Charles Chung-Wei Lin 25 26 , Yusuke Ome 27 , Yasuji Seyama 27 , Roberto I Troisi 28 29 , Giammauro Berardi 29 , Fernando Rotellar 30 , Gregory C Wilson 31 , David A Geller 31 , Olivier Soubrane 32 , Tomoaki Yoh 32 , Takashi Kaizu 33 , Yusuke Kumamoto 33 , Ho-Seong Han 34 , Ela Ekmekcigil 34 , Ibrahim Dagher 35 , David Fuks 36 , Brice Gayet 36 , Joseph F Buell 37 , Ruben Ciria 38 , Javier Briceno 38 , Nicholas O'Rourke 39 , Joel Lewin 39 , Bjorn Edwin 40 , Masahiro Shinoda 41 , Yuta Abe 41 , Mohammed Abu Hilal 42 43 , Mohammad Alzoubi 43 44 , Minoru Tanabe 15 , Go Wakabayashi 45
Less morbidity is considered among the advantages of laparoscopic liver resection (LLR) for HCC patients. However, our previous international, multi-institutional, propensity score-based study of emerging laparoscopic repeat liver resection (LRLR) failed to prove this advantage.
We hypothesize that these results may be since the study included complex LRLR cases performed during the procedure's developing stage. To examine it, subgroup analysis based on propensity score were performed, defining the proximity of the tumors to major vessels as the indicator of complex cases.
Among 1582 LRLR cases from 42 international high-volume liver surgery centers, 620 cases without the proximity to major vessels (more than 1 cm far from both first-second branches of Glissonian pedicles and major hepatic veins) were selected for this subgroup analysis.
A propensity score matching (PSM) analysis was performed based on their patient characteristics, preoperative liver function, tumor characteristics and surgical procedures. One hundred and fifteen of each patient groups of LRLR and open repeat liver resection (ORLR) were earned, and the outcomes were compared. Backgrounds were well-balanced between LRLR and ORLR groups after matching. With comparable operation time and long-term outcome, less blood loss (283.3±823.0 vs. 603.5±664.9 mL, p = 0.001) and less morbidity (8.7 vs. 18.3 %, p = 0.034) were shown in LRLR group than ORLR.
Even in its worldwide developing stage, LRLR for HCC patients could be beneficial in blood loss and morbidity for the patients with less complexity in surgery.
CITA DEL ARTÍCULO Cancers (Basel). 2021 Jun 25;13(13):3187. doi: 10.3390/cancers13133187.