1 Department of Surgery, University of Verona, Verona, Italy.
2 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
3 Department of Surgery, Ospedale San Raffaele, Milan, Italy.
4 Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
5 Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.
6 Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
7 Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
8 Department of Surgery, Stanford University, Stanford, CA, USA.
9 Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
10 Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
11 Department of Surgery, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia.
12 Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA. firstname.lastname@example.org.
13 Department of Surgery, The Urban Meyer III and Shelley Meyer Chair in Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA. email@example.com.
BACKGROUND: Patients with hepatocellular carcinoma (HCC) and portal vein hypertension assessed with platelet count (PVH-PLT; platelet count < 100,000/mL) are often denied surgery even when the disease is technically resectable. Short- and long-term outcomes of patients undergoing minimally invasive surgery (MIS) versus open resection for HCC and PVH-PLT were compared.
METHODS: Propensity score matching (PSM) was used to balance the clinicopathological differences between MIS and non-MIS patents. Univariate comparison and standard survival analyses were utilized.
RESULTS: Among 1974 patients who underwent surgery for HCC, 13% had a PVH-PLT and 33% underwent MIS. After 1:1 PSM, 407 MIS and 407 non-MIS patients were analyzed. Incidence of complications and length-of-stay (LoS) were higher among non-MIS versus MIS patients (both p ≤ 0.002). After PSM, among 178 PVH-PLT patients (89 MIS and 89 non-MIS), patients who underwent a non-MIS approach had longer LoS (> 7 days; non-MIS: 55% vs. MIS: 29%), as well as higher morbidity (non-MIS: 42% vs. MIS: 29%) [p <0.001]. In contrast, long-term oncological outcomes were comparable, including 3-year overall survival (non-MIS: 66.2% vs. MIS: 72.9%) and disease-free survival (non-MIS: 47.3% vs. MIS: 50.2%) [both p ≥ 0.08].
CONCLUSION: An MIS approach was associated with improved short-term outcomes, but similar long-term outcomes, compared with open liver resection for patients with HCC and PVH-PLT. An MIS approach for liver resection should be considered for patients with HCC, even those individuals with PVH-PLT.