Journal of Hepatocellular Carcinoma (Dec 2023)

Surgical Strategies Affect the Long-Term Prognosis of Patients with Hepatocellular Carcinoma Adjacent to the Left Branch of the Portal Vein

  • Bai S,
  • Shen X,
  • Liu J,
  • Lu C,
  • Wang J,
  • Liu L,
  • Wang C,
  • Wang H,
  • Liu K,
  • Sun Y,
  • Xue F

Journal volume & issue
Vol. Volume 10
pp. 2355 – 2366

Abstract

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Shilei Bai,1,* Xiaojing Shen,2,* Jianwei Liu,1,* Caixia Lu,1 Jie Wang,1 Liu Liu,1 Chunyan Wang,1 Huifeng Wang,3 Kai Liu,4 Yanfu Sun,1 Feng Xue1 1Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, People’s Republic of China; 2Department of Pathology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 3Department of Hepatic Surgery, the Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, People’s Republic of China; 4Department of Biliary Tract Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Feng Xue; Yanfu Sun, Department of Hepatic Surgery II, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Naval Medical University), 225 Changhai Road, Shanghai, 200433, People’s Republic of China, Tel +86-21-81875513, Fax +86-21-65562400, Email [email protected]; [email protected]: When hepatocellular carcinoma (HCC) is closely associated with the left branch of the portal vein, there is still controversy regarding the surgical approach.Methods: This study enrolled 330 HCC patients with tumors adjacent to the left branch of the portal vein. Among them, 85 patients underwent left hemihepatectomy (LH), while the remaining 235 underwent liver lobectomy (LL), which included left medial segmentectomy or left lateral sectionectomy. Perioperative complications, time to recurrence and overall survival (OS) were compared using propensity score matching.Results: LH resulted in a lower 5-year recurrence rate and higher 5-year OS rate than LL (56.5% vs 74.0%, p=0.002; 67.4% vs 53.5%, p=0.029). The LL group showed a higher tendency for early recurrence (ER) and intrahepatic recurrence (IR). The cumulative IR rates at 1- 3-, and 5-years for the LH group and the LL group were 17.0%, 36.7%, 45.1% and 33.8%, 57.1%, 63.7%, respectively, with a p-value of 0.007. There was no statistically significant difference in the cumulative ER rates between the two groups at 1-, 3-, and 5- years. Furthermore, the LH group and the LL group had similar perioperative complications, and no cases of liver failure occurred.Conclusion: LH, compared to LL, reduced the IR rate and ER rate in HCC patients with tumor adjacent to the left branch of the portal vein. It improved the OS outcome of the patients, and there was no significant difference in perioperative complications between the two groups.Keywords: hepatocellular carcinoma, left hemihepatectomy, liver lobectomy, propensity score matching, recurrence, overall survival

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