Mini-Invasive Approach Contributes to Expand the Indication for Liver Resection for Hepatocellular Carcinoma Without Increasing the Incidence of Posthepatectomy Liver Failure and Other Perioperative Complications: A Single-Center Analysis.
BACKGROUND
Liver resection (LR) for hepatocellular carcinoma (HCC) is the best alternative option for increasing the survival of many patients with intermediate or advanced stages of the Barcelona Clinic Liver Cancer staging classification. Mini-invasive approach may play a positive role in treating a tumor rising almost exclusively in a diseased liver.


METHODS
A prospectively collected database was retrospectively reviewed for 167 consecutive patients who underwent LR between 1999 and 2015.


RESULTS
A total of 38 LRs were performed from 1999 to 2009 (Period I), and 129 between 2010 and 2015 (Period II). Laparoscopic procedures increased from 5.3% to 38.1%. Not undergoing laparoscopic LR increased length of stay, and Clavien Grade II or worse complications. Ninety-day mortality decreased from 5.2% to 0%, and morbidity did not differ significantly, despite the fact that the most complex patients were in Period II.


CONCLUSIONS
Mini-invasive approaches allow to safely expand limits of LR for HCC; in particular, laparoscopic approach favors surgical option even in more complex patients without increase the risk of posthepatic liver failure or other postsurgical complications.
1 Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) , Palermo, Italy .
Salvatore
S
Gruttadauria
1 Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) , Palermo, Italy .
Alessandro
A
Tropea
1 Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) , Palermo, Italy .
Duilio
D
Pagano
2 Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo , Palermo, Italy .
Aurelia
A
Guarini
3 Pathology Service, Department of Diagnostic and Therapeutic Services, fIRCCS-ISMETT , Palermo, Italy .
Rosa
R
Liotta
4 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
Tian
T
Ling
5 Office of Research, IRCCS-ISMETT , Palermo, Italy .
Fabio
F
Tuzzolino
6 Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT , Palermo, Italy .
Angelo
A
Luca
7 Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT , Palermo, Italy .
Giovanni
G
Vizzini
1 Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione) , Palermo, Italy .
Bruno
B
Gridelli
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome