Anterior Versus Classical Approach During Right Hepatectomy for Hepatocellular Carcinoma: Inverse Propensity Score Weighted Analysis

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2023 Jul 5

PMID 37407897

Authors

Rami Rhaiem

Daniele Sommacale

Perrine Zimmermann

Koceila Amroun

Ahmad Tashkandi

Alexis Laurent

Giuliana Amaddeo

Julien Calderaro

Alain Luciani

Alexandra Heurgue

Gerard Thiefin

Tullio Piardi

Reza Kianmanesh

Raffaele Brustia

Affiliations

Soon will be listed here.

Abstract

Background: Eastern data highlight the oncological benefits of the anterior approach (AA) during right hepatectomy (RH) for hepatocellular carcinoma (HCC). However, to our knowledge, previous western data on this topic are scarce. In this study, the oncological outcomes of AA and classical approach (CA) during RH for HCC were compared.

Methods: A retrospective inverse propensity score-weighted fashion (IPTW) case-control study was performed in two French hepatobiliary surgery departments. Overall survival (OS), disease-free survival (DFS), and early recurrence rate (within 2 years after surgery) were analyzed.

Results: Survival analysis was performed for 114 patients (CA group,60 patients; AA group, 54 patients). Before IPTW adjustment, the 3-year DFS rates were 29.4% (AA group) and 44% (CA group), respectively. No significant differences were found in DFS (HR = 1.1, 95%CI:0.62-1.9, p = 0.77) and OS (HR = 1.2, 95%CI:0.54-2.6, p = 0.66). After IPTW, DFS and OS analyses showed no differences between the two groups (p = 0.77 and p = 0.46, respectively). Early recurrence rates were similar before and after IPTW. Satellite nodules were the only significant independent risk factor for recurrence.

Conclusion: AA and CA did not result in significant differences in DFS, OS, or early recurrence after right hepatectomy for HCC before and after IPTW.

References

Xu X, Xing H, Han J, Li Z, Lau W, Zhou Y . Risk Factors, Patterns, and Outcomes of Late Recurrence After Liver Resection for Hepatocellular Carcinoma: A Multicenter Study From China. JAMA Surg. 2018; 154(3):209-217. PMC: 6439634. DOI: 10.1001/jamasurg.2018.4334. View

Tung-Ping Poon R, Fan S, Wong J . Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000; 232(1):10-24. PMC: 1421103. DOI: 10.1097/00000658-200007000-00003. View

Belghiti J, Guevara O, Noun R, Saldinger P, Kianmanesh R . Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001; 193(1):109-11. DOI: 10.1016/s1072-7515(01)00909-7. View

Hao S, Fan P, Chen S, Tu C, Wan C . Anterior approach to improve the long-term outcome in patients with large-size hepatocellular carcinoma having liver resection. J Surg Oncol. 2016; 114(7):872-878. DOI: 10.1002/jso.24433. View

Wang C, Jawade K, Yap A, Concejero A, Lin C, Chen C . Resection of large hepatocellular carcinoma using the combination of liver hanging maneuver and anterior approach. World J Surg. 2010; 34(8):1874-8. DOI: 10.1007/s00268-010-0546-9. View

Chan K, Wang Y, Wu T, Lee C, Wu T, Chou H . The Preference for Anterior Approach Major Hepatectomy: Experience Over 3 Decades and a Propensity Score-Matching Analysis in Right Hepatectomy for Hepatocellular Carcinoma. Medicine (Baltimore). 2015; 94(34):e1385. PMC: 4602929. DOI: 10.1097/MD.0000000000001385. View

Wu T, Wang F, Lin Y, Chan K, Yu M, Lee W . Right hepatectomy by the anterior method with liver hanging versus conventional approach for large hepatocellular carcinomas. Br J Surg. 2010; 97(7):1070-8. DOI: 10.1002/bjs.7083. View

Liu C, Fan S, Cheung S, Lo C, Ng I, Wong J . Anterior approach versus conventional approach right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled study. Ann Surg. 2006; 244(2):194-203. PMC: 1602174. DOI: 10.1097/01.sla.0000225095.18754.45. View

Belghiti J . Editorial perspective: Resection of large hepatocellular carcinoma using combination of liver hanging maneuver and anterior approach. World J Surg. 2010; 34(8):1879-80. DOI: 10.1007/s00268-010-0593-2. View

10.

Nagino M, DeMatteo R, Lang H, Cherqui D, Malago M, Kawakatsu S . Proposal of a New Comprehensive Notation for Hepatectomy: The "New World" Terminology. Ann Surg. 2021; 274(1):1-3. DOI: 10.1097/SLA.0000000000004808. View

11.

Vandenbroucke J, von Elm E, Altman D, Gotzsche P, Mulrow C, Pocock S . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007; 4(10):e297. PMC: 2020496. DOI: 10.1371/journal.pmed.0040297. View

12.

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

13.

Rahbari N, Garden O, Padbury R, Brooke-Smith M, Crawford M, Adam R . Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011; 149(5):713-24. DOI: 10.1016/j.surg.2010.10.001. View

14.

Mise Y, Vauthey J, Zimmitti G, Parker N, Conrad C, Aloia T . Ninety-day Postoperative Mortality Is a Legitimate Measure of Hepatopancreatobiliary Surgical Quality. Ann Surg. 2015; 262(6):1071-8. PMC: 4633391. DOI: 10.1097/SLA.0000000000001048. View

15.

Hermanek P, Wittekind C . Residual tumor (R) classification and prognosis. Semin Surg Oncol. 1994; 10(1):12-20. DOI: 10.1002/ssu.2980100105. View

16.

Seaman S, White I, Copas A, Li L . Combining multiple imputation and inverse-probability weighting. Biometrics. 2011; 68(1):129-37. PMC: 3412287. DOI: 10.1111/j.1541-0420.2011.01666.x. View

17.

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

18.

Ozawa K . Hepatic function and liver resection. J Gastroenterol Hepatol. 1990; 5(3):296-309. DOI: 10.1111/j.1440-1746.1990.tb01632.x. View

19.

Lai E, Fan S, Lo C, Chu K, Liu C . Anterior approach for difficult major right hepatectomy. World J Surg. 1996; 20(3):314-7; discussion 318. DOI: 10.1007/s002689900050. View

20.

Liu C, Fan S, Lo C, Tung-Ping Poon R, Wong J . Anterior approach for major right hepatic resection for large hepatocellular carcinoma. Ann Surg. 2000; 232(1):25-31. PMC: 1421104. DOI: 10.1097/00000658-200007000-00004. View