Quality of surgical care has a significant impact on the probability of cure for early stage HCC occurring on cirrhosis

ABSTRACT Background & Aims The quality of surgical care of patients with hepatocellular carcinoma (HCC) is associated with improved long-term prognosis and may also be influenced by the type of surgical approach. The present study aimed at evaluating the role of the laparoscopic approach on quality of surgical care and long-term prognosis in optimal HCC surgical candidates. Methods All consecutive patients undergoing open (OLR) or laparoscopic (LLR) liver resection for early-stage HCC on cirrhosis (METAVIR F4) at five French expert HPB centers between 2010-2018 were enrolled. Quality of surgical care was defined by textbook outcome (TO), a combination of 6 criteria representing ideal hospitalization. Factors associated with TO were determined on multivariate analysis. Comparison between LLR and OLR was performed after propensity score matching (PSM). The primary endpoint was disease-free survival (DFS). Statistical cure was modeled using a non-mixture model. Results Overall, 425 patients were included. Median follow-up was 42.0 months. LLR was performed in 267 (62.8%) patients. TO was achieved in 140 (32.9%) patients. LLR was independently associated with TO (OR: 2.81; 95% CI: 1.29 to 6.12; p=0.009). After PSM, LLR patients cumulated higher number of TO criteria than OLR patients (5 vs. 4; p=0.012). One, three and five-year DFS of LLR patients with and without TO were 82.3%, 64.4%, 62.5% and 76.9%, 51.4% and 30.2%, respectively (p=0.003). On multivariable cox regression TO was independently associated with improved DFS (HR=0.34; p=0.001). The cure fraction of the whole population was 24.4%. Patients achieving TO had increased cure fraction than patients not achieving TO (32.6% vs. 18.1%). Conclusion Quality of surgical care improves the prognosis of patients with early-stage HCC and is promoted by the laparoscopic approach.