Laparoscopic liver resection for hepatocellular carcinoma complicated with significant portal hypertension: A propensity score-matched survival analysis

作者全名："Guo, Zhang-You; Hong, Yuan; Tu, Bing; Cheng, Yao; Wang, Xiao-Mei"

作者地址："[Guo, Zhang-You] Kunming Med Univ, Yunnan Canc Hosp, Dept Minimally Invas Intervent Therapy, Yunnan Canc Ctr,Affiliated Hosp 3, Kunming 650118, Peoples R China; [Hong, Yuan] Kunming Med Univ, Inst Expt Diagnost Yunnan Prov, Key Lab Lab Med Yunnan Prov, Med Lab,Affiliated Hosp 1, Kunming 650032, Peoples R China; [Tu, Bing; Cheng, Yao; Wang, Xiao-Mei] Chongqing Med Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Chongqing 400010, Peoples R China"

通信作者："Wang, XM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Hepatobiliary Surg, Chongqing 400010, Peoples R China."

来源：HEPATOBILIARY & PANCREATIC DISEASES INTERNATIONAL

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001039608800001

JCR分区：Q2

影响因子：3.6

年份：2023

卷号：22

期号：4

开始页：358

结束页：365

文献类型：Article

关键词：Hepatocellular carcinoma; Significant portal hypertension; Laparoscopic liver resection; Propensity score matching analysis

摘要："Background: Significant portal hypertension (SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma (HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH.Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection (LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching (PSM) analysis was performed to minimize bias.Results: A total of 165 patients were divided into two groups based on the presence (SPH, n = 76) or absence (non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group ( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate ( n = 0), overall postoperative complications (47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification ( P = 0.347), conversion to open surgery (9.2% vs. 6.7%, P = 0.557), or length of hospitalization (16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM (log-rank P > 0.05). After PSM, alpha-fetoprotein (AFP) & GE; 400 & mu;g/L [hazard ratio (HR) = 4.71, 95% confidence interval (CI): 2.69-8.25], ascites (HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists (ASA) classification (III vs. II) (HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm (HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS.Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.& COPY; 2022 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved."

基金机构："National Natu-ral Science Foundation of China [81701950, 82172135]; Medical Research Projects of Chongqing [2020FYYX248]; Kuanren Talents Program of the Second Affiliated Hospital, Chongqing Medical University [KY2019Y002]"

基金资助正文："This work was supported by grants from the National Natural Science Foundation of China (81701950 and 82172135) , Medical Research Projects of Chongqing for staff against the epidemic (2020FYYX248) , and the Kuanren Talents Program of the Second Affiliated Hospital, Chongqing Medical University (KY2019Y002) ."