Hepatobiliary surgery and nutrition最新文献

Background: Postoperative pulmonary complications (PPCs) can impact patient recovery and long-term oncological outcomes after hepatectomy. This study aimed to define whether laparoscopic approach was associated with a reduced incidence of PPCs compared with open approach for patients undergoing hepatectomy for hepatocellular carcinoma (HCC).

Methods: A multicenter, retrospective cohort study was conducted at 12 Chinese centers between January 2010 and December 2021. Patients underwent either laparoscopic hepatectomy (LH) or open hepatectomy (OH) for HCC. The primary outcome was the incidence of PPCs including symptomatic pleural effusion, respiratory insufficiency, acute respiratory distress syndrome (ARDS), pulmonary infection, and pulmonary embolism. Statistical analysis was performed using propensity score analysis with inverse probability of treatment-weighing (IPTW), multivariable logistic regression, and subgroup analysis to adjust for potential confounders and explore the robustness of the findings.

Results: Among 4,694 patients, 766 (16.3%) patients underwent LH while 3,928 (83.7%) underwent OH for HCC. The overall incidence of PPCs was 10.9%. Among the entire cohort, the incidence of PPCs among patients who underwent LH was significantly lower than individuals who underwent OH (7.3% vs. 11.6%, P=0.001); IPTW analysis demonstrated similar findings (7.4% vs. 11.6%, P=0.01). On multivariable analysis, laparoscopic approach remained independently associated with a lower risk of PPCs [adjusted odds ratio (OR) 0.63, 95% confidence interval (CI): 0.42-0.92, P=0.02]. Subgroup analyses demonstrated similar results relative to different patient and tumor characteristics.

Conclusions: Laparoscopic approach was associated with improved postoperative pulmonary outcomes and a lower incidence of PPCs than open approach the following hepatectomy for HCC. These findings have potentially important implications in selecting optimal surgical management for HCC.

Background: The efficacy and safety of combining portal vein ligation (PVL) with apatinib and camrelizumab to make hepatocellular carcinoma (HCC) with insufficient future-liver-remnant (FLR) resectable are uncertain. This study aimed to explore the potential of PVL combined with systemic therapy in the treatment of HCC with insufficient FLR.

Methods: In this single-arm, prospective phase II clinical trial (PLACES study), patients with HCC and inadequate FLR underwent initial PVL followed by apatinib and camrelizumab until they met the stage-II resection criteria. Post-hepatectomy, adjuvant therapy with apatinib and camrelizumab continued for one year. The primary endpoint was 1 year event-free survival (EFS) rate, defined as the time from phase I surgery to disease progression, postoperative recurrence, or death from any cause. Clinical profiles were compared to historical cases of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) at the same center using propensity score matching (PSM).

Results: Thirty patients were enrolled in the PLACES study. The objective response rate was 26.7% (8/30, RECIST v1.1) or 40% (12/30, mRECIST). Twenty-three (76.7%, 23/30) achieved sufficient FLR, and out of those, 20 (66.7%, 20/30) completed stage-II hepatectomy. The 1-year EFS rate in the PLACES group was found to be 63.3% [95% confidence interval (CI): 48.2-83.1%]. Twenty patients (66.7%, 20/30) experienced grade ≥3 treatment-related adverse events, with hypoalbuminemia being the most common (>50%). Fecal microbiological analysis suggested that Escherichia-Shigella and Enterococcus might be pre-treatment biomarkers of efficacy. We also constructed responsive and non-responsive genetic signatures as post-treatment biomarkers. Compared with the historical ALPPS group, the PLACES group demonstrated better higher EFS (not reach vs. 10.2 months, P=0.040) and overall survival (not reach vs. 19.5 months, P=0.046).

Conclusions: PVL combined with apatinib and camrelizumab emerged as a promising therapy for HCC with inadequate FLR, demonstrating both efficacy and safety (chictr.org number, ChiCTR2000033692).