LAPAROSCOPIC LIVER RESECTION AS A TREATMENT FOR EARLY-STAGE HEPATOCELLULAR CARCINOMA IN PATIENTS WITH AND WITHOUT PORTAL HYPERTENSION: A CASE-CONTROL STUDY

Introduction and Objectives

In patients with early-stage Hepatocellular Carcinoma (HCC), liver transplantation is the ideal treatment, but it is not universally available. Laparoscopic Liver Resection (LLR) offers comparable outcomes and is recommended for patients without clinically significant portal hypertension (CSPH). This study aimed to compare perioperative and short-term outcomes of LLR in cirrhotic patients with early-stage HCC, with and without CSPH.

Patients and Methods

This retrospective case-control study included 40 cirrhotic patients with early-stage HCC who underwent LLR between 2016-2023 at a university hospital. Clinical and demographic variables, indirect signs of portal hypertension and HVPG were recorded. Patients were divided into two groups, presence or absence of CSPH (HVPG >10 mmHg or clinical signs of portal hypertension). The non-CSPH group included 15 patients (37.5%) and the CSPH included 25 patients (62.5%), with a median HVPG of 16 [11–26] mmHg. Median follow-up was 25 [2–89] months. Perioperative variables and outcomes up to 90 days post-surgery, as well as clinical follow-up data, were compared. Fisher’s exact test and Kaplan-Meier survival analysis with the log-rank test were used for statistical analysis. A p-value <0.05 was considered statistically significant.

Results

There were no differences in baseline characteristics or preoperative tumor size between the groups. A total of 78% of LLRs were anatomical segmentectomies. Intraoperative variables showed no significant differences. No 90-day mortality was observed. No significant differences were found in postoperative rates of ascites (13% vs. 24%), post-hepatectomy liver failure (13% vs. 0%), encephalopathy (0 vs. 4%), decompensation (20% in both), or infections. The median ICU stay was 4 days for both groups. Positive surgical margins (R1) were also similar (7% vs. 12%). Overall survival rates at 1 and 3 years were 100% and 78%, respectively, with no significant differences (p=0.1448).

Conclusions

In patients with CSPH, early postoperative outcomes and short-term survival were comparable to those patients without CSPH.

Conflict of interest: None