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Laparoscopic liver resection for hepatocellular carcinoma complicated with significant portal hypertension:A propensity score-matched survival analysis

查看全文 作　　者：Zhang-You [1]Guo;Yuan [2]Hong;Bing [3]Tu;Yao [3]Cheng;Xiao-Mei [3]Wang 高影响力作者 机构地区：[1]Department of Minimally Invasive Interventional Therapy,Yunnan Cancer Hospital,The Third Affiliated Hospital of Kunming Medical University,Yunnan Cancer Center,Kunming 650118,China;[2]Medical Laboratory,The First Affiliated Hospital of Kunming Medical University,Institute of Experimental Diagnostics of Yunnan Province,Key Laboratory of Laboratory Medicine of Yunnan Province,Kunming 650032,China;[3]Department of Hepatobiliary Surgery,The Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China高影响力机构 出　　处：《Hepatobiliary & Pancreatic Diseases International》索引2023年第22卷第4期,共8页高影响力期刊 基　　金：supported by grants from the National Natu-ral Science Foundation of China(81701950 and 82172135);Medi-cal Research Projects of Chongqing for staffagainst the epidemic(2020FYYX248);the Kuanren Talents Program of the Second Affiliated Hospital,Chongqing Medical University(KY2019Y002). 摘　　要：Background: Significant portal hypertension(SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma(HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH. Methods: HCC patients with cirrhosis who underwent laparoscopic liver resection(LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching(PSM) analysis was performed to minimize bias. Results: A total of 165 patients were divided into two groups based on the presence(SPH, n = 76) or absence(non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group( P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate( n = 0), overall postoperative complications(47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification( P = 0.347), conversion to open surgery(9.2% vs. 6.7%, P = 0.557), or length of hospitalization(16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival(OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM(log-rank P > 0.05). After PSM, alpha-fetoprotein(AFP) ≥ 400 μg/L [hazard ratio(HR) = 4.71, 95% confidence interval(CI): 2.69-8.25], ascites(HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists(ASA) classification(Ⅲ vs. Ⅱ)(HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm(HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS. Conclusions: LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR. 关 键 词：Hepatocellular carcinoma Significant portal hypertension Laparoscopic liver resection Propensity score matching analysis
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