Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach

Abstract

Aim: The study was designed to assess the implications of enhanced recovery after surgery (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma (HCC) comparing their short term outcome with patients treated by laparoscopic approach, in a case-matched design.

Methods: The open-group (n = 60) was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC (Lap-group, n = 60), with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease. Primary outcome analysis was performed in terms of ERAS-specific items and postoperative morbidity and mortality.

Results: Overall morbidity and mortality were comparable between groups. Incidence of ascites was slightly higher in the open- compared with the Lap-group (respectively 11.7% and 13.3%), without statistical significance. The need for introduction or increase of chronic diuretic therapy was significantly higher in the open-compared with the Lap-group (16.7% vs. 11.7%, P = 0.046). Furthermore, ascites more frequently required percutaneous drainage in the open-compared with the Lap-group (5% vs. 1.7% respectively, P = 0.041).

Conclusion: In patients who can’t benefit from minimally-invasive approach because of disease characteristics, ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes, comparable to those of the minimally invasive approach.

Keywords

Hepatocellular carcinoma / fast track / laparoscopy / liver surgery / enhanced recovery after surgery / liver failure

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