Safety and Efficacy of Laparoscopic Portal Territory Fluorescence Navigation-guided Anatomical Liver Resection in Hepatocellular Carcinoma Patients

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2025 Mar 6

PMID 40050494

Authors

An-Zhi Wang

Rui Zhou

Jie Chen

Fan Zhang

Jing-Yang Du

Ya-Jin Chen

Jun Cao

Affiliations

Soon will be listed here.

Abstract

Background: The clinical effectiveness of classic anatomical resection (CAR) of the liver for hepatocellular carcinoma (HCC) has been controversial. Laparoscopic Portal Territory fluorescence navigation-guided anatomical liver resection (LPTAR) has been increasingly applied in clinical practice. However, evidence on the safety and efficacy of LPTAR is lacking.

Methods: A retrospective cohort study of patients who underwent laparoscopic hepatectomy from December 2018 to December 2022 was conducted. Propensity score matching (PSM) was employed to match patients who underwent LPTAR with patients who underwent CAR. Differences in recurrence-free survival (RFS), overall survival (OS), and perioperative data were evaluated between the LPTAR and CAR groups. Cox regression models were used for univariate and multivariate analyses, as well as subgroup analyses.

Results: Of the 234 patients included in this study, 70 underwent LRTAR, and 164 underwent CAR. After 1:1 PSM, each group contained 59 patients, and perioperative parameters were better in the LPTAR group. Specifically, the LPTAR group had wider resection margins (13.00 cm vs. 11.00 cm, P = 0.023), less blood loss (200 ml vs. 320 ml, P = 0.010), and fewer postoperative complications (33.90% vs. 57.62%, P = 0.016) than did the CAR group. The RFS rates of patients with HCC was also increased by LPTAR. The 1-, 3-, and 5-year RFS rates of the LPTAR group were significantly higher than those of the CAR group (P = 0.002).

Conclusion: Accurate preoperative planning and standardized LPTAR technical criteria prolonged RFS in HCC patients, improved the safety of surgery, and reduced surgical stress.

Trail Registration: The study has been prospective registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2400087661).

References

Shindoh J, Makuuchi M, Matsuyama Y, Mise Y, Arita J, Sakamoto Y . Complete removal of the tumor-bearing portal territory decreases local tumor recurrence and improves disease-specific survival of patients with hepatocellular carcinoma. J Hepatol. 2015; 64(3):594-600. DOI: 10.1016/j.jhep.2015.10.015. View

Siegel R, Giaquinto A, Jemal A . Cancer statistics, 2024. CA Cancer J Clin. 2024; 74(1):12-49. DOI: 10.3322/caac.21820. View

Bruix J, Takayama T, Mazzaferro V, Chau G, Yang J, Kudo M . Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2015; 16(13):1344-54. DOI: 10.1016/S1470-2045(15)00198-9. View

Pinna A, Yang T, Mazzaferro V, De Carlis L, Zhou J, Roayaie S . Liver Transplantation and Hepatic Resection can Achieve Cure for Hepatocellular Carcinoma. Ann Surg. 2018; 268(5):868-875. DOI: 10.1097/SLA.0000000000002889. View

Jung D, Hwang S, Lee Y, Kim K, Song G, Ahn C . Small Hepatocellular Carcinoma With Low Tumor Marker Expression Benefits More From Anatomical Resection Than Tumors With Aggressive Biology. Ann Surg. 2017; 269(3):511-519. DOI: 10.1097/SLA.0000000000002486. View

Ju M, Yopp A . The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?. Cancers (Basel). 2019; 11(10). PMC: 6826719. DOI: 10.3390/cancers11101441. View

Famularo S, Di Sandro S, Giani A, Lauterio A, Sandini M, De Carlis R . Recurrence Patterns After Anatomic or Parenchyma-Sparing Liver Resection for Hepatocarcinoma in a Western Population of Cirrhotic Patients. Ann Surg Oncol. 2018; 25(13):3974-3981. DOI: 10.1245/s10434-018-6730-0. View

Hidaka M, Eguchi S, Okuda K, Beppu T, Shirabe K, Kondo K . Impact of Anatomical Resection for Hepatocellular Carcinoma With Microportal Invasion (vp1): A Multi-institutional Study by the Kyushu Study Group of Liver Surgery. Ann Surg. 2018; 271(2):339-346. DOI: 10.1097/SLA.0000000000002981. View

Takamoto T, Makuuchi M . Precision surgery for primary liver cancer. Cancer Biol Med. 2019; 16(3):475-485. PMC: 6743624. DOI: 10.20892/j.issn.2095-3941.2019.0194. View

10.

Shindoh J, Mise Y, Satou S, Sugawara Y, Kokudo N . The intersegmental plane of the liver is not always flat--tricks for anatomical liver resection. Ann Surg. 2010; 251(5):917-22. DOI: 10.1097/SLA.0b013e3181d773ae. View

11.

Majno P, Mentha G, Toso C, Morel P, Peitgen H, Fasel J . Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections. J Hepatol. 2013; 60(3):654-62. DOI: 10.1016/j.jhep.2013.10.026. View

12.

Liu F, Wang H, Ma W, Li J, Liu Y, Tang S . Short- and Long-Term Outcomes of Indocyanine Green Fluorescence Navigation- Versus Conventional-Laparoscopic Hepatectomy for Hepatocellular Carcinoma: A Propensity Score-Matched, Retrospective, Cohort Study. Ann Surg Oncol. 2023; 30(4):1991-2002. PMC: 10027802. DOI: 10.1245/s10434-022-13027-5. View

13.

Wang X, Cao J, Li J . Anatomic Liver Resection Based on Portal Territory With Margin Priority for Hepatocellular Carcinoma. JAMA Surg. 2024; 159(6):710-711. DOI: 10.1001/jamasurg.2023.5904. View

14.

Zhao H, Chen C, Gu S, Yan X, Jia W, Mao L . Anatomical versus non-anatomical resection for solitary hepatocellular carcinoma without macroscopic vascular invasion: A propensity score matching analysis. J Gastroenterol Hepatol. 2016; 32(4):870-878. DOI: 10.1111/jgh.13603. View

15.

Marubashi S, Gotoh K, Akita H, Takahashi H, Ito Y, Yano M . Anatomical versus non-anatomical resection for hepatocellular carcinoma. Br J Surg. 2015; 102(7):776-84. DOI: 10.1002/bjs.9815. View

16.

Fang C, You J, Lau W, Lai E, Fan Y, Zhong S . Anatomical variations of hepatic veins: three-dimensional computed tomography scans of 200 subjects. World J Surg. 2011; 36(1):120-4. DOI: 10.1007/s00268-011-1297-y. View

17.

Berardi G, Igarashi K, Li C, Ozaki T, Mishima K, Nakajima K . Parenchymal Sparing Anatomical Liver Resections With Full Laparoscopic Approach: Description of Technique and Short-term Results. Ann Surg. 2019; 273(4):785-791. DOI: 10.1097/SLA.0000000000003575. View

18.

Kim W, Lim T, Park P, Choi S, Kim W . Prognostic markers affecting the early recurrence of hepatocellular carcinoma with liver cirrhosis after curative resection. Int J Biol Markers. 2019; 34(2):123-131. DOI: 10.1177/1724600819834306. View

19.

Wakabayashi T, Benedetti Cacciaguerra A, Abe Y, Dalla Bona E, Nicolini D, Mocchegiani F . Indocyanine Green Fluorescence Navigation in Liver Surgery: A Systematic Review on Dose and Timing of Administration. Ann Surg. 2022; 275(6):1025-1034. DOI: 10.1097/SLA.0000000000005406. View

20.

Ishizawa T, Saiura A, Kokudo N . Clinical application of indocyanine green-fluorescence imaging during hepatectomy. Hepatobiliary Surg Nutr. 2016; 5(4):322-8. PMC: 4960410. DOI: 10.21037/hbsn.2015.10.01. View