Propensity Score Matching Study on Laparoscopic Versus Open Resection for Hepatocellular Carcinoma in Patients with Child-Pugh Class B Liver Cirrhosis: An International Multicenter Study

Abstract

Introduction: The difficulty of laparoscopic liver resection (LLR) is increased by the presence of liver cirrhosis. Hepatocellular carcinoma (HCC) occurs frequently on cirrhosis and favorable outcomes of LLR compared to the open has been reported. Despite this, most of the studies included only Child-Pugh A patients while only few cases undergoing LLR with Child-Pugh B (CP-B) cirrhosis have been reported. Method: Patients undergoing laparoscopic or open (OLR) liver resection for HCC in CP-B cirrhosis between January 2002 and December 2017 were retrieved from 13 international centres. A 1:1 Propensity Score matching was performed according to age, sex, BMI, ASA, comorbidities, Child-Pugh number, previous treatment, previous surgery, preoperative portal hypertension, ascites and varices, position of lesions, distance from major vessels, number and size of lesions, year of operation, type of resection and additional procedure. Intraoperative and postoperative outcomes were compared between groups. Kaplan-Meier curves were built for Overall (OS) and disease-free survival (DFS). Result: 253 patients (133 open, 122 laparoscopic) were included. After Propensity Score matching 70 LLR and 70 OLR were analysed. Conversion rate was 5.9%. LLR group had a significantly lower blood loss (110 ml vs. 400ml; p=0.004), lower morbidity rate (37.1% vs. 54.3%; p=0.04) and less major complications (15.4% vs. 36.8%; p=0.01). Postoperative ascites was lower in the LLR group at postoperative day 1, 3 and 5. Hospital stay was 7.5 days in LLR and 18 days in OLR (p=0.05). After a median follow-up of 33 months, The 5 years OS was 45% in OLR and 57% in LLR (p=0.29). The 5 years DFS was 28% in OLR and 31% in LLR (p=0.57). Conclusion: LLR in Child-Pugh B liver cirrhosis could significantly reduce morbidity and liver decompensation compared to the open approach maintaining comparable oncological outcomes.