Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 avenue de Lattre de Tassigny, 94010, Créteil, France.
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Besançon, France.
Surg Endosc. 2019 Mar;33(3):811-820. doi: 10.1007/s00464-018-6347-1. Epub 2018 Jul 12.
The laparoscopic approach might increase the number of cirrhotic patients with hepatocellular carcinoma (HCC) indicated for liver resection, otherwise contraindicated due to portal hypertension. The goal of this study was to confirm the safety of laparoscopic liver resection (LLR) in patients with portal hypertension.
This prospective, single-center, open study (ClinicalTrials.gov ID: NCT02145013) included all consecutive cirrhotic patients who underwent LLR for HCC from 2014 to 2017. Short-term outcomes were compared between patients with and without clinically significant portal hypertension (CSPH, defined by hepatic venous pressure gradient ≥ 10 mmHg).
The study population included 45 patients, comprising 27 patients (60%) in the no CSPH group and 18 patients (40%) in the CSPH group. All planned procedures could be performed. The two groups did not differ in the extent of resection, transfusion, duration of clamping, and need for conversion. Overall, the 90-day mortality and severe morbidity rates were nil. Moderate morbidity was significantly higher in the CSPH group (39 vs. 4%, p = 0.01); however, the two groups did not differ in the rate of unresolved liver decompensation. Intensive care unit and hospital stays were significantly longer in the CSPH group. At 2 years, overall survival was 77% in the no CSPH group and 100% in the CSPH group (p = 0.17), and recurrence-free survival was 55% in the no CSPH group and 79% in the CSPH group (p = 0.10).
LLR is safe in BCLC 0-A patients with CSPH, with no mortality and good short-term outcomes. Re-evaluation of the BCLC guidelines is needed.
腹腔镜方法可能会增加因门脉高压而原本不适合进行肝切除术的肝硬化合并肝细胞癌（HCC）患者的数量。本研究的目的是确认腹腔镜肝切除术（LLR）在门脉高压患者中的安全性。
本前瞻性、单中心、开放研究（ClinicalTrials.gov ID：NCT02145013）纳入了 2014 年至 2017 年间所有因 HCC 而行 LLR 的连续肝硬化患者。比较了伴有和不伴有临床显著门脉高压（CSPH，定义为肝静脉压力梯度≥10mmHg）患者的短期结局。
研究人群包括 45 例患者，其中无 CSPH 组 27 例（60%），CSPH 组 18 例（40%）。所有计划的手术均能完成。两组在切除范围、输血、夹闭时间和需要转化方面无差异。总体而言，90 天死亡率和严重发病率均为零。CSPH 组中度发病率明显更高（39% vs. 4%，p=0.01）；然而，两组在未解决的肝功能失代偿发生率方面无差异。CSPH 组 ICU 和住院时间明显更长。2 年时，无 CSPH 组的总生存率为 77%，CSPH 组为 100%（p=0.17），无 CSPH 组的无复发生存率为 55%，CSPH 组为 79%（p=0.10）。
BCLC 0-A 伴有 CSPH 的患者行 LLR 是安全的，无死亡率且短期结局良好。需要重新评估 BCLC 指南。
