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

作     者：Zhang-You Guo Yuan Hong Bing Tu Yao Cheng Xiao-Mei Wang Zhang-You Guo;Yuan Hong;Bing Tu;Yao Cheng;Xiao-Mei Wang

作者机构：Department of Minimally Invasive Interventional TherapyYunnan Cancer HospitalThe Third Affiliated Hospital of Kunming Medical UniversityYunnan Cancer CenterKunming 650118China Medical LaboratoryThe First Affiliated Hospital of Kunming Medical UniversityInstitute of Experimental Diagnostics of Yunnan ProvinceKey Laboratory of Laboratory Medicine of Yunnan ProvinceKunming 650032China Department of Hepatobiliary SurgeryThe Second Affiliated HospitalChongqing Medical UniversityChongqing 400010China 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2023年第22卷第4期

页      面：358-365页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

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) 

主　　题：Hepatocellular carcinoma Significant portal hypertension Laparoscopic liver resection Propensity score matching analysis 

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). 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 complicat