Abstract
Simple SummaryThe type of surgical approach for the treatment of hepatocellular carcinoma is unclear. This study compared minimally invasive to open liver resections using the National Cancer Database. The results showed a similar overall survival with improved perioperative outcomes, but higher rates of positive resection margins in patients with minimally invasive liver resections. The higher rate of residual tumors requires further investigation.Minimally invasive liver resection (MILR) is increasingly used as a surgical treatment for patients with hepatocellular carcinoma (HCC). However, there is no large scale data to compare the effectiveness of MILR in comparison to open liver resection (OLR). We identified patients with stage I or II HCC from the National Cancer Database using propensity score matching techniques. Overall, 1931 (66%) and 995 (34%) patients underwent OLR or MILR between 2010 and 2015. After propensity matching, 5-year OS was similar in the MILR and OLR group (51.7% vs. 52.8%, p = 0.766). MILR was associated with lower 90-day mortality (5% vs. 7%, p = 0.041) and shorter length of stay (4 days vs. 5 days, p < 0.001), but higher rates of positive margins (6% vs. 4%, p = 0.001). An operation at an academic institution was identified as an independent preventive factor for a positive resection margin (OR 0.64: 95% CI 0.43–0.97) and 90-day mortality (OR 0.61; 95% CI 0.41–0.91). MILR for HCC is associated with similar overall survival to OLR, with the benefit of improved short term postoperative outcomes. The increased rate of positive margins after MILR requires further investigation, as do the differences in perioperative outcomes between academic and nonacademic institutions.
Highlights
Hepatocellular carcinoma (HCC) is the most common primary liver tumor, with an increasing incidence and mortality worldwide [1]
This result is likely to reflect the lack of standardized lymphadenectomy, as almost all patients with available nodal status had negative lymph nodes and lymph node status was not associated with overall survival
3.8%; p = 0.006), whereas the rate of unknown resection margins was low in the Minimally invasive liver resection (MILR) and open liver resection (OLR) groups (3.5% vs. 3.0%)
Summary
Hepatocellular carcinoma (HCC) is the most common primary liver tumor, with an increasing incidence and mortality worldwide [1]. Even though several new agents have been introduced for the first and second line treatment of patients with advanced disease, there has been little change in the management of patients with stage I/II tumors [2]. The role of surgical resection in the management of localized HCC has increased in recent years [6]. This is mirrored by changes in clinical algorithms for HCC treatment [7]. In updated guidelines, Grade A recommendation is given for surgical resection as primary treatment for patients with a solitary tumor of any size, or up to three nodules of ≤3 cm (Barcelona Clinic Liver Cancer (BCLC) stage 0/A), and as an alternative treatment for patients with multinodular disease (BCLC stage B) [8].
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