Detailed Abstract
[Poster Presentation 13 - Liver (Liver Disease/Surgery)]
[LV PP 13-S1] Minimally Invasive Versus Open Liver Resection for Hepatocellular Carcinoma Staged BCLC - B And - C: an Italian Multicentric Inverse Probability Treatment Weighted Analysis
Gianluca CASSESE 1, Alessandro VITALE 2, Luciano DE CARLIS 3, Matteo CESCON 4, Luca ALDRIGHETTI 5, Felice GIULIANTE 6, Pasquale PERRI 7, Marco VIVARELLI 8, Marcello MAESTRI 9, Alessandro FERRERO 10, Massimo ROSSI 11, Andrea RUZZENENTE 12, Marco CHIARELLI 13, Raffaele DELLA VALLE 14, Fabrizio ROMANO 15, Gianluca BAIOCCHI 16, Elio JOVINE 17, Giorgio ERCOLANI 18, Umberto CILLO 2, Roberto Ivan TROISI 1
1 Minimally Invasive And Robotic Hpb Surgery, Department of Clinical Medicine And Surgery, Federico II University, Naples, ITALY, 2 Hepatobiliary Surgery And Liver Transplantation, Department of Surgery, University of Padua, Padua, ITALY, 3 Department of Transplantation, Division of General Surgery And Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, ITALY, 4 Department of Hepatobiliary Surgery And Transplantation, Policlinico Di Sant'Orsola, Istituto Di Ricovero E Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, ITALY, 5 Department of Surgery, Division of Hepatobiliary Surgery, San Raffaele Hospital, Milan, ITALY, 6 Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica Del Sacro Cuore, Rome, ITALY, 7 Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, ITALY, 8 HPB Surgery And Transplantation Unit, Department of Clinical And Experimental Medicine, Polytechnic University of Marche, Ancona, ITALY, 9 Unit of General Surgery 1, University of Pavia And Foundation IRCCS Policlinico San Matteo, Pavia, ITALY, 10 Department of General And Oncological Surgery, Mauriziano Hospital "Umberto I", Turin, ITALY, 11 General Surgery And Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, ITALY, 12 Division of General And Hepatobiliary Surgery, University of Verona, Verona, ITALY, 13 Department of Emergency And Robotic Surgery, ASST Lecco, Lecco, ITALY, 14 Department of Medicine And Surgery, University of Parma, Parma, ITALY, 15 School of Medicine And Surgery, University of Milano-Bicocca, , San Gerardo Hospital, Monza, ITALY, 16 Department of Clinical And Experimental Sciences, University of Brescia, Brescia, ITALY, 17 Alma Mater Studiorum, University of Bologna, AOU Sant'Orsola Malpighi, IRCCS at Maggiore Hospital, Bologna, ITALY, 18 General And Oncologic Surgery, Morgagni-Pierantoni Hospital, Department of Medical And Surgical Sciences - University of Bologna Forlì, ITALY
Background : To date, there is still debate regarding the role of surgery in BCLC-B and C patients, according to BCLC staging system. The safety and efficacy of MILS in such patients has not been widely investigated so far.
Methods : Data regarding patients undergoing liver resection for HCC staged BCLC - B and - C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders between patients undergoing MILS and OLR. Primary outcome was a composite endpoint including PHLF, severe postoperative complications and in-hospital mortality.
Results : 651 patients staged BCLC-B and -C undergoing liver resection for HCC were eligible for this study, including 482 patients undergoing MILS and 169 patients receiving OLR. No difference was found in the composite endpoint between MILS and OLR (OR 0.80 [95%CI 0.43-1-49]; p= 0.39). MILS was found to reduce the risk of receiving intra-operative transfusions (OR 0.30 [95%CI 0.15-0.59]; p < 0.001) and was associated with reduced length of hospital stay (LoS) (OR 0.81 [95%CI 0.66 – 0.99]; p= 0.04). There was no difference in the risk of severe postoperative complications (OR 0.86 [95%CI 0.45-1.62]; p = 0.63). After a median follow-up of 64 months, the survival analysis showed no differences between MILS and OLR (HR 0.80 [95%CI 0.61 – 1.04]; p= 0.10).
Conclusions : MILS was safe and feasible for BCLC-B and -C HCC patients. MILS may reduce the need for intraoperative transfusions and shorten LoS, while not affecting either the risk of severe postoperative complications or survival outcomes.
Methods : Data regarding patients undergoing liver resection for HCC staged BCLC - B and - C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders between patients undergoing MILS and OLR. Primary outcome was a composite endpoint including PHLF, severe postoperative complications and in-hospital mortality.
Results : 651 patients staged BCLC-B and -C undergoing liver resection for HCC were eligible for this study, including 482 patients undergoing MILS and 169 patients receiving OLR. No difference was found in the composite endpoint between MILS and OLR (OR 0.80 [95%CI 0.43-1-49]; p= 0.39). MILS was found to reduce the risk of receiving intra-operative transfusions (OR 0.30 [95%CI 0.15-0.59]; p < 0.001) and was associated with reduced length of hospital stay (LoS) (OR 0.81 [95%CI 0.66 – 0.99]; p= 0.04). There was no difference in the risk of severe postoperative complications (OR 0.86 [95%CI 0.45-1.62]; p = 0.63). After a median follow-up of 64 months, the survival analysis showed no differences between MILS and OLR (HR 0.80 [95%CI 0.61 – 1.04]; p= 0.10).
Conclusions : MILS was safe and feasible for BCLC-B and -C HCC patients. MILS may reduce the need for intraoperative transfusions and shorten LoS, while not affecting either the risk of severe postoperative complications or survival outcomes.
SESSION
Poster Presentation 13
Zone G 3/22/2024 2:50 PM - 3:40 PM