Detailed Abstract
[Liver Oral Presentation 2]
[LV OP 2-3] LONG-TERM RESULTS OF SALVAGE TRANSPLANTATION IN PATIENTS INITIALLY TREATED WITH OPEN VERSUS MINIMALLY INVASIVE LIVER SURGERY
Giovanni Battista LEVI SANDRI*1, Quirino LAI2, Luciano DE CARLIS3, Paolo DE SIMONE4, Salvatore GRUTTADAURIA5, Fabrizio DI BENEDETTO6, Massimo ROSSI2, Giuseppe ETTORRE1, Matteo CESCON7
1Division of General Surgery and Liver Transplantation,, San Camillo Hospital, Italy
2Department of General Surgery and Organ Transplantation,, Umberto I Hospital, Sapienza University,, Italy
3Surgical and Transplant Department, ASST Grande Ospedale Metropolitano Niguarda, Italy
4Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Italy
5Abdominal Surgery and Organ Transplant Unit, Mediterranean Institute for Transplantation and Specialization Therapies (IRCCS-ISMETT), Italy
6Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
7Department of Organ Insufficiency and Transplantation, University Hospital of Bologna, Italy
Introduction : Salvage liver transplantation (SLT) represents a valuable strategy to adopt in patients with hepatocellular carcinoma recurring after initial liver resection (LR). The role of minimally invasive liver surgery (MILS) in the context of SLT has poorly been investigated.
Methods : A multicenter retrospective study was performed in six Italian centers on HCC patients initially resected with open approach versus MILS and then waitlisted for SLT during the period Jan 2007-Dec 2017
Results : 211 patients were included in the study (MILS Group=44; Open Group=167). MILS Group consisted of 25 cases of wedge resection, 16 segmentectomies, two left lateral, and one right posterior bisegmentectomy. At LR, in the MILS Group, we observed less multiple resections (p<0.001); less major resection (p<0.001); and shorter lenght of hospital stay (p=0.024). At SLT, duration of surgery (p<0.001), blood losses (p<0.001) and Calvien-Dindo Grade ≥ IIIa (p=0.03) were reduced in the MILS Group. At multivariable logistic regression for the risk of SLT failure, MILS procedure was a protective factor (OR=0.26). Initial major resection was an independent risk factor for SLT failure, with an OR=3.05. A sub-analysis was performed using a Propensity Score Matching. 44 MILS vs. 44 open cases were matched. MILS confirmed its independent relevance as a protective factor against the risk of SLT failure, with an OR=0.22.
Conclusions : MILS showed a protective role in terms of the risk of salvage liver transplantation failure. This datum was confirmed also after PSM. MILS was also a protective factor for the risk of post-transplant death.
Methods : A multicenter retrospective study was performed in six Italian centers on HCC patients initially resected with open approach versus MILS and then waitlisted for SLT during the period Jan 2007-Dec 2017
Results : 211 patients were included in the study (MILS Group=44; Open Group=167). MILS Group consisted of 25 cases of wedge resection, 16 segmentectomies, two left lateral, and one right posterior bisegmentectomy. At LR, in the MILS Group, we observed less multiple resections (p<0.001); less major resection (p<0.001); and shorter lenght of hospital stay (p=0.024). At SLT, duration of surgery (p<0.001), blood losses (p<0.001) and Calvien-Dindo Grade ≥ IIIa (p=0.03) were reduced in the MILS Group. At multivariable logistic regression for the risk of SLT failure, MILS procedure was a protective factor (OR=0.26). Initial major resection was an independent risk factor for SLT failure, with an OR=3.05. A sub-analysis was performed using a Propensity Score Matching. 44 MILS vs. 44 open cases were matched. MILS confirmed its independent relevance as a protective factor against the risk of SLT failure, with an OR=0.22.
Conclusions : MILS showed a protective role in terms of the risk of salvage liver transplantation failure. This datum was confirmed also after PSM. MILS was also a protective factor for the risk of post-transplant death.
SESSION
Liver Oral Presentation 2
Room A 7/27/2020 1:42 PM - 1:49 PM