Liver Resection For Hepatocellular Carcinoma Research Articles

Effect of Performance Status on Short-term and Long-Term Outcomes After Liver Resection for Hepatocellular Carcinoma: A Multicenter Study

Background: The Barcelona Clinic Liver Cancer (BCLC) categorizes a patient with performance status (PS)-1 as advanced stage of hepatocellular carcinoma (HCC) and surgical resection is not recommended. However, in real-world clinical practice, PS-1 is often not a contraindication to surgery for HCC. The aim of current study was to define the impact of PS on the surgical outcomes of patients undergoing liver resection for HCC. Methods: Using a multi-institutional database, 1,531 consecutive patients who underwent a curative-intent resection of HCC between 2005 and 2015 were identified. After categorizing patients into PS-0 (n=836) versus PS-1 (n=695), perioperative mortality and morbidity, overall survival (OS) and recurrence-free survival (RFS) were compared. Results: Overall perioperative mortality and major morbidity among patients with PS-0 (n=836) and PS-1 (n=695) were similar (1.4% vs. 1.6%, P=0.525 and 9.7% vs. 10.2%, P=0.732, respectively). In contrast, median OS and RFS was worse among patients who had PS-1 versus PS-0 (34.0 vs. 107.6 months, and 20.5 vs. 60.6 months, both P< 0.001, respectively). On multivariable Cox-regression analyses, PS-1 was independently associated with worse OS (HR: 1.301, 95% CI: 1.111-1.523, P < 0.001) and RFS (HR: 1.184, 95% CI: 1.034-1.358, P = 0.007). Conclusions: Patients with PS-1 versus PS-0 had comparable perioperative outcomes. However, patients with PS-1 had worse long-term outcomes as PS-1 was independently associated with worse OS and RFS. Routine exclusion of HCC patients with PS-1 from surgical resection as recommended by the BCLC guidelines is not warranted.

Risk Factors, Patterns and Long-Term Prognosis of Early and Late Recurrence in Patients with Hepatitis B Virus-Associated Hepatocellular Carcinoma

Background: Survival after liver resection of hepatocellular carcinoma (HCC) remains poor due to a high incidence of recurrence. We sought to investigate risk factors, patterns, and long-term prognosis among patients with early and late recurrence after liver resection for hepatitis B virus (HBV)-associated HCC.

Anatomic vs. non-anatomic liver resection for hepatocellular carcinoma: standard of care or unfilled promises?

Anatomic vs. non-anatomic liver resection for hepatocellular carcinoma: standard of care or unfilled promises?

Conditional disease-free survival after liver resection for HCC

Background: A high recurrence rate after resection of hepatocellular carcinoma (HCC) is one of the most debated issues in literature.Conditional survival is defined as the probability of surviving for another “Y” years, given that the person has already survived “X” years and is derived from the concept of conditional probability in biostatistics. The literature about conditional disease-free survival (CDFS) in patients with HCC after curative resection is very limited.The study aim was to investigate the long-term change in tumor recurrence risk in disease-free patients (DFS) after hepatic resection for HCC. Recurrence probability over time was estimated by CDFS analysis. Methods: 477 consecutive patients that underwent liver resection surgery with curative intent for HCC at the General and Hepatobiliary Surgery Department of the University of Verona from May 1989 to December 2020 were retrospectively analyzed.Long-term endpoints were the DFS, i.e., the time elapsed between the intervention and the first relapse (or the last follow up in case of no relapse) and calculation of the conditional disease-free survival (CDFS) specified as the 1, 2 and 3-year CDFS, which represents the probability of remaining disease-free for an additional 1, 2 and 3 years. Besides, prognostic factors associated with disease-free survival were identified and the change in their impact over time was analyzed. Results: Disease-free survival was 68.2%, 53.6%, 41.6% at 1, 2 and 3 years. Conditional disease-free survival rates of the entire study population based on the time already lived after surgical resection have been evaluated.There were significant differences between DFS and CDFS. The disease-free survival at 5 years was 27.0%, but patients who had already 3 years of disease-free after surgery, had a 64.9% chance of having a further 2 years of disease-free survival. Prognostic factors for DFS and their changes over time have been evaluated. We found that multinodular HCC, HCV, macrovascular invasion and high AFP were significantly related to DFS in baseline analysis, but these factors were no longer related with DFS after X months. Cirrhosis remains the only risk factor for recurrence with statistical significance over the 3 years of DFS. Conclusions: Conditional disease-free survival analysis shows that the prognosis varies over time and is an important tool that can provide more accurate and dynamic prognostic information useful to guide follow-up strategies.

Comparative Study of Propensity Score Matching Method and Benchmark Article Method on the Outcomes of Major Laparoscopic and Major Open Liver Resection for Hepatocellular Carcinoma

Comparative Study of Propensity Score Matching Method and Benchmark Article Method on the Outcomes of Major Laparoscopic and Major Open Liver Resection for Hepatocellular Carcinoma

Predictive factors for long-term survival after hepatic resection for hepatocellular carcinoma: a single-center experience

Aim To evaluate our center’s experience of liver resection for hepatocellular carcinoma (HCC) to determine the predictive factors affecting tumor recurrence and long-term survival. Patients and methods We reviewed the data of all consecutive patients who underwent liver resection for pathologically confirmed HCC during the period between January 2010 and June 2018. Results A total of 230 consecutive patients were included in the study. Hepatitis C virus was the main underlying cause among our patients (214 patients − 93.04%). The median operation time was 180 min (70–420 min), and the median blood loss was 700 ml (100–6000 ml). Postoperative morbidities occurred in 138 (60%) patients. Internal hemorrhage occurred in six (2.6%) patients. A total of 12 (5.2%) patients experienced biliary complications. Liver dysfunction occurred in 126 (54.7%) cases, and most of them were only grade A liver dysfunction (70 patients − 55.5%). The median follow-up duration was 22 months (4–110 months). Recurrence occurred in 132 (62.5%) patients. The 1-, 3-, and 5-year disease-free survival rates were 69.2, 35.4, and 17.6%, respectively. Late mortality occurred in 61 (26.5%) patients. The 1-, 3-, and 5-year overall survival rates were 78.2, 59.1, and 50%, respectively. Predictive factors for recurrence included alpha-fetoprotein, tumor number, macrovascular invasion, tumor size, and microvascular invasion. Predictive factors for long-term survival included macrovascular invasion, vascular complications, tumor size, and microvascular invasion. Conclusion Liver resection is one of the curative treatment strategies for HCC; however, the long-term prognosis is disappointing owing to the high incidence of tumor recurrence.

Peri-operative outcomes of liver resection for hepatocellular carcinoma in 1,936 pediatric patients: a retrospective population based study (NIS 1998-2014)

Presenter: Sushruta S Nagarkatti MD | Ascension Providence Hospital Background: Hepatocellular carcinoma (HCC) accounts for less than 0.5% of all pediatric malignancies. The etiology and biology of pediatric HCC differs from that seen in adults. However, as in the adult population, surgical resection offers the highest chance of survival. The available literature on the outcomes of hepatic resection in this age group is scarce and is limited by small sample sizes. This is the first population based study analyzing demographic and clinical characteristics as well as peri-operative outcomes of liver resection in pediatric HCC patients Methods: The National Inpatient Database (NIS 1998-2014) was used to identify pediatric patients (age ≤19 years) diagnosed with hepatocellular carcinoma (ICD-9 code 155.0), who had either partial hepatectomy (ICD 9 code 50.22) or liver lobectomy (ICD 9 code 50.3). Discharge weights were applied to obtain national estimates. Demographic, clinical and outcomes data was compared using standard statistical methodology. Results: A total of 1,936 pediatric patients who underwent surgical resection for HCC were identified. The mean age was 4.9 years, with a male to female ratio 1.18:1. Formal anatomic lobectomy was performed in 56.4% with 43.6% of patients undergoing a non-anatomic partial hepatectomy. The all-cause mortality rate was 1.8%, with an overall complication rate of 15.2%. Post-operative hemorrhage occurred in 4.6% patients, with the most common complications being respiratory (7.7%) and GI (7.6%). Overall, the post-operative infection rate was low at 2.4% with < 1.0% of patients developing sepsis. Most patients were discharged home (83.1%) with a mean LOS 11.6 (±12.9) days. Home health services were required for 10.2% of patients with 4.6% requiring subacute rehab services or a skilled nursing facility ( <1.0%). Conclusion: The majority of pediatric HCC patients received a formal anatomic liver lobectomy with reported morbidity and mortality far lower than the published literature on similar procedures in adult HCC patients. Further studies are needed to validate the findings of this study and establish long term survival outcomes in this patient population.

Effectiveness of the Albumin-bilirubin Score as a Prognostic Factor for Early Recurrence after Curative Hepatic Resection for Hepatocellular Carcinoma

Introduction: The albumin-bilirubin (ALBI) score has been validated as a predictor of disease-free survival and overall survival in hepatocellular carcinoma (HCC). The purpose of this study was to assess the ALBI score as a risk factor for early recurrence (ER) after curative liver resection in HCC. Methods: Patients who underwent liver resection with curative intent for HCC without previous treatment between January 2004 and December 2014 were included in this retrospective study. The utility of the ALBI score in predicting ER and late recurrence (LR) was evaluated. Results: A total of 465 HCC patients were enrolled; multivariate analysis identified ALBI grade ≥2 (p=0.003) as a risk factor for ER, in addition to hepatitis B virus surface antigen (HBsAg)-positive status (p < 0.001), tumor size ≥3.5cm (p≤0.001), lymph-vascular invasion (p=0.001), and the presence of satellite lesions (p=0.009). In subgroup analysis for ALBI grade 1, Model for End-stage Liver Disease score >9 (p=0.046), HBsAg positive status (p=0.004), tumor size ≥3.5 cm (p < 0.001), lymph-vascular invasion (p=0.001), presence of satellite lesions (p=0.002), and poor tumor differentiation (p=0.007) were independent risk factors for ER; however, in subgroup analysis for ALBI grade 2, no significant associations with ER were found. Kaplan-Meier curve analysis showed that long-term survival in HCC with ER was significantly shorter than in patients with LR. Conclusions: The ALBI score was a preoperative risk factor for ER and may be useful in determining appropriate management according to liver function when recurrence develops.

Travel distance and overall survival in hepatocellular cancer care

BackgroundOur objective was to assess the relationship between overall survival (OS) and distance travelled to the treating facility for patients undergoing liver resection for hepatocellular carcinoma and to determine whether this relationship was dependent upon the structural factors of the treating facility. MethodsUsing National Cancer Database, we focused on extremes of travel: Local (<12.5 miles to treating facility) and Travel (≥50 miles). We analyzed OS with Cox models; we estimated stratified models to assess interaction between distance and facility characteristics (volume, academic status). ResultsWe included 6860 patients. After correction for confounding, distance travelled was not associated with OS (p = 0.444). However, Travel patients treated at high-volume, academic centers had worse OS compared to Local patients (HR 1.54, 95%CI 1.07–2.21); this association was not seen for patients treated at low volume, academic centers (p = 0.708) high volume non-academic centers (p = 0.174) or low volume non-academic centers (p = 515). ConclusionFor those patients treated at high-volume, academic centers, living far from the facility was associated with worse OS. The reasons for this association should be investigated further.

Preoperative Controlling Nutritional Status plus Tumor Burden Score for the Assessment of Prognosis after Curative Liver Resection for Hepatocellular Carcinoma

Objective: There are no previous studies analyzing the prognostic predictive value of adding the tumor factor (i.e., Tumor Burden (TB) score) to the Controlling Nutritional Status (CONUT) score for patients with hepatocellular carcinoma (HCC). This study aimed to investigate the value of the CONUT plus TB (CONUT-TB) score as a prognostic predictor in patients with HCC undergoing liver resection. Methods: Between 2015 and 2018, 96 consecutive patients with HCC underwent liver resection at our institution. Patients undergoing repeated liver resection and combined resection of a metastatic lesion were excluded. Patients were divided into 2 groups according to their CONUT-TB scores according to a cutoff value. Clinicopathologic prognostic factors for survival were analyzed using a database containing the medical records. Results: The optimal cutoff value of the CONUT-TB score determined by using a minimum p value approach was 13 points. Among the 81 patients included in the analytic cohort, 71 patients had low (<13) and 10 patients had high (>13) CONUT-TB scores. The overall 3-year survival rate of patients following liver resection for HCC in the high-CONUT-TB group was significantly worse than that of patients in the low-CONUT-TB group (62.5 vs. 89.3%, p = 0.003). Multivariate analysis indicated that a high CONUT-TB score was independently associated with overall survival after liver resection (p = 0.010). Conclusion: The CONUT-TB score is a valuable predictor of survival in patients with HCC after liver resection.

Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma.

Simple SummaryThe comprehensive complication index (CCI) and the Clavien-Dindo Complication (CDC) scoring system are two metrics designed to quantify the burden of postoperative morbidity. We performed a retrospective study retrieving data from a multi-institutional Italian register. The aim was to compare the performance of the two metrics in predicting excessive length of hospital stay (e-LOS) of patients who underwent liver resections for hepatocellular carcinoma. A total of 2669 patients were analyzed. A derivation (n = 1345) and validation sets (n = 1324) were created to test the strength of results. In both cohorts, the analysis showed that CCI was slightly superior in predicting e-LOS in complicated patients. The accuracy of CCI was even better when considering a subgroup of patients who experienced at least two complications. The results of this population-specific analysis suggest that CCI is preferable in weighting postoperative morbidity burden.Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Bridging and downstaging role of trans-arterial radio-embolization for expected small remnant volume before liver resection for hepatocellular carcinoma.

Backgrounds/AimsTo evaluate our initial experience of bridging role of trans-arterial radio-embolization (TARE) before major hepatectomy for hepatocellular carcinoma (HCC) in risky patients with small expected remnant liver volume (ERLV).MethodsWe reviewed the data of patients with HCC who underwent major hepatectomy after TARE during the period between March and December 2017. Patients included had uni-lobar large HCC (>5 cm) requiring major hepatectomy with small ERLV.ResultsFive patients were included in our study. All patients were Child Pugh class A. A single session of TARE was applied in all patients. None developed any adverse events related to irradiation. The mean tumor size at baseline was 8.4 cm and 6.1 cm after TARE (p=0.077). The mean % of tumor shrinkage was 24.5%. ERLV improved from 354.6 ml at baseline to 500.8 ml after TARE (p=0.012). ERLV percentage improved from 27.2% at baseline to 38.1% after TARE (p=0.004). The mean % of ERLV was 39.5%. The mean interval time between TARE and resection was 99.6 days. Four patients (80%) underwent right hemi-hepatectomy and one patient (20%) underwent extended right hemi-hepatectomy. The mean operation time was 151 minutes, and mean blood loss was 56 ml. The mean hospital stay was 13.8 days, and one patient (20%) developed postoperative morbidity. After a mean follow-up of 15 months, all patients were alive with no recurrence.ConclusionsYttrium-90 TARE can play a bridging role before major hepatectomy for borderline resectable HCC in risky patients with small ERLV.

Six months as a cutoff time point to define early recurrence after liver resection of hepatocellular carcinoma based on post-recurrence survival.

To determine the optimal cutoff time point of early versus late recurrence relative to post-recurrence survival (PRS) among patients who underwent liver resection (LR) for hepatocellular carcinoma (HCC) in a high-volume liver surgery center in East Asia. This was a retrospective study. Patients who underwent LR for HCC between 2011 and 2018 at Kaohsiung Chang Gung Memorial Hospital were enrolled. The optimal cutoff time point to differentiate early versus late recurrence was evaluated relative to PRS. Among 826 patients, 282 (34.1%) of the patients experienced recurrence, with a median time to recurrence of 12.2months. 6months was defined as the optimal cutoff time point based on sensitivity analyses relative to PRS. Ninety (31.9%) of the patients developed early recurrence within 6months, and 192 patients (68.1%) developed late recurrence beyond 6months. Early recurrence was associated with worse PRS (median PRS, 13.2 versus 48.9months, p < 0.001), as well as overall survival (OS) (median OS, 16.2 versus 65.4months, p < 0.001), than late recurrence. Six months was identified as the cutoff time point to differentiate early versus late recurrence among patients undergoing LR for HCC.

Outcomes in Patients with Chronic Kidney Disease After Liver Resection for Hepatocellular Carcinoma.

The aim of this study was to clarify the feasibility of liver resection in hepatocellular carcinoma (HCC) patients with chronic kidney disease (CKD). In all, 204 patients who underwent primary liver resection for HCC between 2011 and 2019 were analyzed. Short-term and long-term outcomes were compared between the CKD and control groups. The CKD group was defined by a preoperative estimated glomerular filtration rate (eGFR) < 45mL/min/1.73m2 and chronic kidney disease Stage 3B or higher. Twenty-eight patients (13.7%) had CKD. No significant differences were observed in the overall complication rates between the groups (46.4% vs. 34.7% p = 0.229). The incidence of bile leakage was significantly higher in the CKD group than in the control group (14.3% vs. 4.0% p = 0.048), and the median postoperative hospital stay was significantly longer in the CKD group (11 vs. 9days p = 0.031). No significant differences were found in the disease-free survival between the two groups (p = 0.763), but overall survival (OS) was significantly worse in the CKD group than in the control group (p = 0.022). In the multivariable analysis, a CKD diagnosis (hazard ratio, 2.261; 95% confidence interval (CI), 1.139-4.486 p = 0.020) was identified as an independent poor prognostic factor for OS. The percentage of patients who died from cardiovascular disease was significantly higher in the CKD group (27.3% vs. 2.3% p = 0.023). Liver resection for HCC in CKD patients is associated with acceptable perioperative outcomes. However, cardiovascular disease may negatively affect the OS of CKD patients after liver resection.

Improved outcomes of major laparoscopic liver resection for hepatocellular carcinoma

BackgroundMinor laparoscopic liver resection (LLR) is currently becoming standard treatment option for hepatocellular carcinoma (HCC) while major LLR is still challenging. Recent advancement of surgical techniques has enabled surgeons to perform major LLR. This study compared the outcomes of major LLR for HCC before and after the adaptation of technological improvements. MethodsWe retrospectively analyzed 141 patients who underwent major LLR for HCC from January 2004 to July 2018.32 open conversion cases were excluded. We divided the patients into two groups according to the date of operation: Group 1 (n = 38) and Group 2 (n = 71) who underwent major LLR before and after 2012, when advanced techniques including the use of intercostal trocars, Pringle maneuver, and semi-lateral position of patient were introduced. We also compared these patients including open conversion cases (n = 141) with those who underwent major open liver resection (OLR; n = 131) during the same period. ResultsMean operative time (413.0 min vs 331.0 min; P = 0.009), transfusion rate (31.6% vs 11.3%, P = 0.009) and hospital stay (9.8 days vs 8.5 days; P = 0.001) were significantly less in Group 2. Intraoperative blood loss (1269.7 ml vs 844.5 ml; P = 0.341) and postoperative complication (15.8% vs 23.9%; P = 0.320) were not significantly different between the groups. Although tumor size in OLR group and type of resection was different, transfusion rate (36.6% vs 24.1%; P = 0.026), postoperative complication (41.2% vs 25.5%; P = 0.007), and hospital stay (17.2 days vs 10.0 days; P < 0.001) were significantly lower in LLR group. ConclusionDevelopment of surgical techniques have gradually improved the surgical outcomes of the laparoscopic major liver resection.

Selection of patients with esophageal varices for liver resection of hepatocellular carcinoma

The presence of esophageal varices (EV) is a phenotype of portal hypertension, and the indications of liver resection for hepatocellular carcinoma (HCC) in patients with concomitant EV are conflicting. This retrospective study aimed to elucidate if there is justification for liver resection in patients with EV. The surgical outcomes were compared between the patients who underwent resection for HCC with EV (EV group) and those without EV (non-EV group) after propensity-score matching. More bleeding was prevalent (P < 0.001) and refractory ascites was more frequently observed (P = 0.031) in the EV group (n = 277) compared with the non-EV group (n = 277); however, the numbers of patients with morbidities (P = 0.740) and re-operation (P = 0.235) were not significantly different between the two groups. After a median follow-up period of 3.0 years, the median overall and recurrencefree survival periods of patients with EV were 4.8 years (95% confidence interval [CI], 4.1-5.9) and 1.7 years (1.5-2.0), respectively, and were significantly shorter than those of patients without EV (7.6 years [95% CI, 6.3.9.7], P < 0.001, and 2.2 years [1.9-2.5], P = 0.016). On multivariate analysis, the independent factors for overall survival in the EV group were indocyanine green clearance rate at 15 minutes, des-gamma carboxyprothrombin, and the presence of multiple tumors. Considering that liver resection for patients with EV can be safely performed, it should not be contraindicated. However, surgical outcomes of these patients were unsatisfactory, suggesting that candidates for resection for HCC should be carefully selected.

Liver resection for hepatocellular carcinoma in patients with clinically significant portal hypertension.

Background & AimsLiver resection (LR) in patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg is not encouraged. Here, we reappraised the outcomes of patients with cirrhosis and CSPH who underwent LR for HCC in highly specialised liver centres.MethodsThis was a retrospective multicentre study from 1999 to 2019. Predictors for postoperative liver decompensation and textbook outcomes were identified.ResultsIn total, 79 patients with a median age of 65 years were included. The Child-Pugh grade was A in 99% of patients, and the median model for end-stage liver disease (MELD) score was 8. The median HVPG was 12 mmHg. Major hepatectomies and laparoscopies were performed in 28% and 34% of patients, respectively. Ninety-day mortality and severe morbidity rates were 6% and 27%, respectively. Postoperative and persistent liver decompensation occurred in 35% and 10% of patients at 3 months. Predictors of liver decompensation included increased preoperative HVPG (p = 0.004), increased serum total bilirubin (p = 0.02), and open approach (p = 0.03). Of the patients, 34% achieved a textbook outcome, of which the laparoscopic approach was the sole predictor (p = 0.004). The 5-year overall survival and recurrence-free survival rates were 55% and 43%, respectively.ConclusionsPatients with cirrhosis, HCC and HVPG ≥10 mmHg can undergo LR with acceptable mortality, morbidity, and liver decompensation rates. The laparoscopic approach was the sole predictor of a textbook outcome.Lay summaryPatients with cirrhosis, hepatocellular carcinoma, and clinically significant portal hypertension (defined as a hepatic venous pressure gradient ≥10 mmHg) can undergo resection with acceptable mortality, morbidity, liver decompensation rates, and a textbook outcome. These results can be achieved in selected patients with preserved liver function, good general status, and sufficient remnant liver volume.

Laparoscopic liver resection for hepatocellular carcinoma: a single-center experience in upper egypt

Background Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Liver transplantation is an effective therapy for HCC but cannot be done in all HCC cases. Hepatic resection is the first-line therapy for HCC in compensated cirrhosis with proven cure. Laparoscopic liver resection (LLR) of HCC had a lower frequency of postoperative complications than open approach. Aim The aim was to determine the feasibility, safety, and outcome of LLR for HCC in a single center. Patients and methods This study was done on patients with HCC who underwent laparoscopic resection during 2 years. LLR was decided by the surgical team based on the location of the tumor and its size in imaging. All cases were cirrhotic Child–Pugh class A with a single focal lesion. Operative time, blood loss volume, hospital stay, and postoperative complications were reported. Results This study included 20 HCC cases with a mean age 55.6±9.1 years. Of them, 60% were male. The mean size of focal lesion was 3.9±0.8 cm. Wedge resection was done in 65% of cases. Left lateral anatomical resection was done in 35%. Duration of operation ranged from 70 to 120 min. Bleeding occurred in one case only and was converted to open (5%). Hospital stays ranged from 2 to 4 days. Postoperative ascites occurred in one (5%) case. No short-term mortality was seen. Conclusion Laparoscopic minor hepatectomy is an acceptable approach in selected cases of HCC with decreased blood loss, shorter stay in the hospital, and less complications.

The Impact of Hospital Volume on Failure to Rescue after Liver Resection for Hepatocellular Carcinoma: Analysis from the HE.RC.O.LE.S. Italian Registry.

The aim of this study was to evaluate correlation between centers' volume and incidence of failure to rescue (FTR) following liver resection for hepatocellular carcinoma (HCC). FTR, defined as the probability of postoperative death among patients with major complication, has been proposed to assess quality of care during hospitalization. Perioperative management is challenging in cirrhotic patients and the ability to recognize and treat a complication may be fundamental to rescue patients from the risk of death. Patients undergoing liver resection for HCC between 2008 and 2018 in 18 Centers enrolled in the He.Rc.O.Le.S. Italian register. Early results included major complications (Clavien ≥3), 90-day mortality, and FTR and were analyzed according to center's volume. Among 1935 included patients, major complication rate was 9.4% (8.6%, 12.3%, and 7.0% for low-, intermediate- and high-volume centers, respectively, P = 0.001). Ninety-day mortality rate was 2.6% (3.7%, 4.2% and 0.9% for low-, intermediate- and high-volume centers, respectively, P < 0.001). FTR was significantly higher at low- and intermediate-volume centers (28.6% and 26.5%, respectively) than at high-volume centers (6.1%, P = 0.002). Independent predictors for major complications were American Society of Anesthesiologists (ASA) >2, portal hypertension, intraoperative blood transfusions, and center's volume. Independent predictors for 90-day mortality were ASA >2, Child-Pugh score B, BCLC stage B-C, and center's volume. Center's volume and BCLC stage were strongly associated with FTR. Risk of major complications and mortality was related with comorbidities, cirrhosis severity, and complexity of surgery. These factors were not correlated with FTR. Center's volume was the only independent predictor related with severe complications, mortality, and FTR.

Models to predict disease-free survival for hepatocellular carcinoma patients with surgical resections.

Precise prognostic prediction for an individual hepatocellular carcinoma (HCC) patient before and after liver resection is important. We aimed to establish simple prognostic models to predict disease-free survival (DFS) for these patients. Six hundred and ninety-eight HCC patients with liver resections were reviewed. Preoperative (model 1) and postoperative (model 2) nomogram-based scoring systems were constructed by multivariate analyses, and DFS was estimated. Among 698 patients, 490 (70.2%) patients had tumor recurrence at a median follow-up of 84.4 months. Risk factors of tumor recurrence in model 1 included viral hepatitis, platelet count, albumin, indocyanine green retention rate, multiplicity of tumor, and radiologic total tumor volume (TTV). Prognostic variables identified in model 2 were viral hepatitis, platelet count, multiplicity of tumor, cirrhosis, microvascular invasion, and pathologic TTV. By nomogram in model 1, the patients were classified into three groups with 5-year DFS of 61.0%, 35.7%, and 21.1%, respectively (P < .0001). In model 2, the patients were divided into five groups with 5-year DFS of 58.0%, 43.7%, 24.0%, 15.4%, and 0.0%, respectively (P < .0001). Based on nomogram models, DFS for the patients who had liver resection for HCC can be predicted before liver resection and re-assessed after liver resection.