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Hobeika C, Nault JC, Barbier L, Schwarz L, Lim C, Laurent A, Gay S, Salamé E, Scatton O, Soubrane O, Cauchy F. Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis. JHEP Rep 2020; 2:100153. [PMID: 32995713 PMCID: PMC7502347 DOI: 10.1016/j.jhepr.2020.100153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND & AIMS The quality of surgical care of patients with HCC is associated with improved long-term prognosis and may also be influenced by the type of surgical approach. The present study aimed at evaluating the role of the laparoscopic approach on quality of surgical care and long-term prognosis in optimal HCC surgical candidates. METHODS All consecutive patients undergoing open (OLR) or laparoscopic liver resection (LLR) for early-stage HCC in cirrhosis (METAVIR F4) at 5 French expert hepato-pancreatico-biliary centres between 2010 and 2018 were enrolled. Quality of surgical care was defined by textbook outcome (TO), a combination of 6 criteria representing ideal hospitalisation. Factors associated with TO were determined on multivariate analysis. Comparison between LLR and OLR was performed after propensity score matching (PSM). The primary endpoint was disease-free survival (DFS). Statistical cure was modelled using a non-mixture model. RESULTS Overall, 425 patients were included. Median follow-up was 42.0 months. LLR was performed in 267 (62.8%) patients. TO was achieved in 140 (32.9%) patients. LLR was independently associated with TO (odds ratio [OR] 2.81; 95% CI 1.29-6.12; p = 0.009). After PSM, LLR patients cumulated higher number of TO criteria than OLR patients (5 vs. 4; p = 0.012). The 1-, 3-, and 5-year DFS of LLR patients with and without TO were 82.3%, 64.4%, and 62.5%, and 76.9%, 51.4%, and 30.2%, respectively (p = 0.003). On multivariable Cox regression, TO was independently associated with improved DFS (hazard ratio 0.34; p = 0.001). The cure fraction of the whole population was 24.4%. Patients achieving TO had increased cure fraction than patients not achieving TO (32.6% vs. 18.1%). CONCLUSIONS Quality of surgical care improves the prognosis of patients with early-stage HCC and is promoted by the laparoscopic approach. LAY SUMMARY The overall quality of surgical care, as measured by TO, plays a pivotal role in the prognosis and, in particular, on the probability of statistical cure of patients with resectable early-stage HCC occurring in cirrhosis. By influencing TO, laparoscopy has an indirect impact on the probability of cure and long-term management of these patients. This study strongly supports the promising curative role of mini-invasive treatments for early-stage HCC, such as low-difficulty LLR.
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Key Words
- AFP, alpha-fetoprotein
- ALBI, albumin-bilirubin
- CCI, Comprehensive Complication Index
- CT, computed tomography
- DFS, disease-free survival
- HPB, hepato-pancreatico-biliary
- HR, hazard ratio
- Hepatocellular carcinoma
- IMM, Institut Mutualiste Montsouris
- ISGLS, International Study Group of Liver Surgery
- LLR, laparoscopic liver resection
- LOS, length of stay
- LR, liver resection
- Laparoscopic liver resection
- MELD, model for end-stage liver disease
- OLR, open liver resection
- OR, odds ratio
- OS, overall survival
- PHLF, post-hepatectomy liver failure
- Quality of care
- Statistical cure
- TO, textbook outcome
- Textbook outcome
- VIF, variance inflation factor
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Affiliation(s)
- Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
- Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jean Charles Nault
- Liver Unit, Jean Verdier Hospital, Bondy, France
- Assistance Publique-Hôpitaux de Paris, Université Paris-XIII, Paris, France
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris-XIII, Paris, France
- Centre de Recherche des Cordeliers, Inserm, Sorbonne Université, Université Paris, INSERM UMR 1148 Functional Genomics of Solid Tumors laboratory, F-75006, Paris, France
| | - Louise Barbier
- Department of Digestive, Endocrine, HPB Surgery and Liver Transplantation, Trousseau University Hospital, Tours, France
- INSERM U1082, Poitiers, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Chetana Lim
- Department of HPB Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris, Université Paris Sorbonne, Paris, France
| | - Alexis Laurent
- Department of Digestive Surgery, Henri Mondor Hospital, Creteil, France
- Assistance Publique-Hôpitaux de Paris, Université Paris-Est Creteil, Paris, France
| | - Suzanne Gay
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Ephrem Salamé
- Department of Digestive, Endocrine, HPB Surgery and Liver Transplantation, Trousseau University Hospital, Tours, France
- INSERM U1082, Poitiers, France
| | - Olivier Scatton
- Department of HPB Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
- Centre de Recherche Sur l'Inflammation, Inserm, Université de Paris, INSERM UMR 1149 De l'Inflammation au Cancer Laboratory, Paris, France
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
- Centre de Recherche Sur l'Inflammation, Inserm, Université de Paris, INSERM UMR 1149 De l'Inflammation au Cancer Laboratory, Paris, France
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