Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis
Christian Hobeika, Jean‐Charles Nault, Louise Barbier, Lilian Schwarz, Chétana Lim, Alexis Laurent, Suzanne Gay, Ephrem Salamé, Olivier Scatton, Olivier Soubrane, François Cauchy
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: 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.