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Protective benefit of minimally invasive liver surgery for hepatocellular carcinoma prior to transplant

摘要Aim: The purpose of this study is to assess the benefit of laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) given recurrence and future need for liver transplantation (LT). Methods: Data on liver resections were gathered from the Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT) from 2003-2021. A retrospective analysis of 1408 consecutive adult patients who had a liver resection was performed with categorization based on the underlying disease process. A sub-analysis studied the 291 patients who had an LLR with an intention to transplant approach after LLR. Results: From 2012 to 2020, ISMETT's mean annual LLR rate was 45%. Data suggests that a laparoscopic approach to iterative surgical treatment for HCC has demonstrated protective benefits. Compared to open surgery or LT, LLR is protective against the risk of de-listing, post-transplant patient death, tumor recurrence, adhesions, and bleeding in a cirrhotic patient. Kaplan Meier's analysis showed no difference between post-LT survival curves for those with prior open abdominal surgery or LLR (P = 0.658). Conclusion: Laparoscopic surgery has important protective advantages over laparotomy surgery for the surgical treatment of HCC, particularly since treatment is not always curative. LLR can be considered a bridge therapy for transplantation, ensuring less crowding of waiting lists, a desirable condition in areas of donor storage.

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作者 Simone Khouzam [1] Duilio Pagano [2] Marco Barbara [2] Vito Di Marco [3] Giada Pietrosi [2] Marco Maringhini [4] Marco Canzonieri [2] Sergio Calamia [2] Salvatore Gruttadauria [5] 学术成果认领
作者单位 Sidney Kimmel Medical College,Thomas Jefferson University,Philadelphia,PA 19107,USA [1] Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation,IRCCS-ISMETT(Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione),UPMC(University of Pittsburgh Medical Center),via E.Tricomi 5,Palermo 90127,Italy [2] Sezione di Gastroenterologia e Epatologia,Dipartimento Biomedico di Medicina Interna e Specialistica,University of Palermo,Palermo 90128,Italy [3] Medicina Interna,Universitàdi Palermo/ISMETT,Via del Vespro 129,Palermo 90127,Italy [4] Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation,IRCCS-ISMETT(Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per I Trapianti e Terapie ad Alta Specializzazione),UPMC(University of Pittsburgh Medical Center),via E.Tricomi 5,Palermo 90127,Italy;Department of Surgery and Medical and Surgical Specialties,University of Catania,Catania 95124,Italy [5]
栏目名称 Original Article
DOI 10.20517/2394-5079.2021.147
发布时间 2022-05-19
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