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

Ann Surg. 2023 Nov 1;278(5):e1041-e1047. doi: 10.1097/SLA.0000000000005861. Epub 2023 Mar 30.

Abstract

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.

Publication types

  • Multicenter Study

MeSH terms

  • Ascites / complications
  • Ascites / surgery
  • Carcinoma, Hepatocellular* / complications
  • Carcinoma, Hepatocellular* / surgery
  • Hepatectomy
  • Humans
  • Laparoscopy*
  • Length of Stay
  • Liver Failure* / surgery
  • Liver Neoplasms* / complications
  • Liver Neoplasms* / surgery
  • Metabolic Syndrome* / complications
  • Metabolic Syndrome* / surgery
  • Postoperative Complications / epidemiology
  • Postoperative Complications / surgery
  • Propensity Score
  • Retrospective Studies